Department of Neurosurgery, La Pitié-Salpêtrière University Hospital, Paris, France; Sorbonne University, Paris, France; Paris Brain Institute, Paris, France.
Department of Neurosurgery, La Pitié-Salpêtrière University Hospital, Paris, France.
Handb Clin Neurol. 2022;187:531-556. doi: 10.1016/B978-0-12-823493-8.00007-9.
Temporal lobe epilepsy (TLE) is the most common cause of refractory epilepsy amenable for surgical treatment and seizure control. Surgery for TLE is a safe and effective strategy. The seizure-free rate after surgical resection in patients with mesial or neocortical TLE is about 70%. Resective surgery has an advantage over stereotactic radiosurgery in terms of seizure outcomes for mesial TLE patients. Both techniques have similar results for safety, cognitive outcomes, and associated costs. Stereotactic radiosurgery should therefore be seen as an alternative to open surgery for patients with contraindications for or with reluctance to undergo open surgery. Laser interstitial thermal therapy (LITT) has also shown promising results as a curative technique in mesial TLE but needs to be more deeply evaluated. Brain-responsive stimulation represents a palliative treatment option for patients with unilateral or bilateral MTLE who are not candidates for temporal lobectomy or who have failed a prior mesial temporal lobe resection. Overall, despite the expansion of innovative techniques in recent years, resective surgery remains the reference treatment for TLE and should be proposed as the first-line surgical modality. In the future, ultrasound therapies could become a credible therapeutic option for refractory TLE patients.
颞叶癫痫（TLE）是最常见的适合手术治疗和控制癫痫发作的难治性癫痫病因。TLE 的手术治疗是一种安全有效的策略。在接受内侧或皮质颞叶 TLE 手术切除的患者中，无癫痫发作的比例约为 70%。与立体定向放射外科相比，内侧 TLE 患者的手术切除在癫痫发作结果方面具有优势。两种技术在安全性、认知结果和相关成本方面具有相似的结果。因此，对于有手术禁忌或不愿接受手术的患者，立体定向放射外科应被视为开放性手术的替代方法。激光间质热疗（LITT）作为内侧 TLE 的一种有前途的治愈技术也显示出了良好的效果，但需要进一步深入评估。脑反应性刺激代表了单侧或双侧 MTLE 患者的姑息性治疗选择，这些患者不适合进行颞叶切除术，或先前的内侧颞叶切除术失败。总的来说，尽管近年来创新技术不断扩展，手术切除仍然是 TLE 的参考治疗方法，应作为一线手术方式提出。未来，超声治疗可能成为难治性 TLE 患者的一种可靠治疗选择。
