Pitskhelauri David, Kudieva Elina, Vlasov Pavel, Eliseeva Natalya, Zaitsev Oleg, Kamenetskaya Maria, Kozlova Antonina, Shishkina Ludmila, Danilov Gleb, Sanikidze Alexander, Kuprava Tekla, Ishkinin Ruslan, Melikyan Armen
N. N. Burdenko National Medical Research Center of Neurosurgery, Ministry of Health of the Russian Federation, 16 4th Tverskaya-Yamskaya St, 125047, Moscow, Russia.
Sechenov University, Moscow, Russia.
Acta Neurochir (Wien). 2023 May;165(5):1215-1226. doi: 10.1007/s00701-023-05536-3. Epub 2023 Mar 3.
At present, selective amygdalohippocampectomy (SAH) has become popular in the treatment of drug-resistant mesial temporal lobe epilepsy (TLE). However, there is still an ongoing discussion about the advantages and disadvantages of this approach.
The study included a consecutive series of 43 adult patients with drug-resistant TLE, involving 24 women and 19 men (1.8/1). Surgeries were performed at the Burdenko Neurosurgery Center from 2016 to 2019. To perform subtemporal SAH through the burr hole with the diameter of 14 mm, we used two types of approaches: preauricular, 25 cases, and supra-auricular, 18 cases. The follow-up ranged from 36 to 78 months (median 59 months). One patient died 16 months after surgery (accident).
By the third year after surgery, Engel I outcome was achieved in 80.9% (34 cases) of cases and Engel II in 4 (9.5%) and Engel III and Engel IV in 4 (9.6%) cases. Among the patients with Engel I outcomes, anticonvulsant therapy was completed in 15 (44.1%), and doses were reduced in 17 (50%) cases. Verbal and delayed verbal memory decreased after surgery in 38.5% and 46.1%, respectively. Verbal memory was mainly affected by preauricular approach in comparison with supra-auricular (p = 0.041). In 15 (51.7%) cases, minimal visual field defects were detected in the upper quadrant. At the same time, visual field defects did not extend into the lower quadrant and inside the 20° of the upper affected quadrant in any case.
Burr hole microsurgical subtemporal SAH is an effective surgical procedure for drug-resistant TLE. It involves minimal risks of loss of visual field within the 20° of the upper quadrant. Supra-auricular approach, compared to preauricular, results in a reduction in the incidence of upper quadrant hemianopia and is associated with a lower risk of verbal memory impairment.
目前，选择性杏仁核海马切除术（SAH）在耐药性内侧颞叶癫痫（TLE）的治疗中已变得流行。然而，对于这种方法的优缺点仍在进行讨论。
该研究纳入了连续的43例成年耐药性TLE患者，其中女性24例，男性19例（比例为1.8/1）。手术于2016年至2019年在布尔坚科神经外科中心进行。为通过直径14毫米的骨孔进行颞下SAH，我们采用了两种方法：耳前入路25例，耳上入路18例。随访时间为36至78个月（中位时间59个月）。1例患者术后16个月死亡（意外事故）。
术后第三年，80.9%（34例）的患者达到Engel I级结果，4例（9.5%）达到Engel II级，4例（9.6%）达到Engel III级和Engel IV级。在达到Engel I级结果的患者中，15例（44.1%）完成了抗惊厥治疗，17例（50%）减少了剂量。术后言语记忆和延迟言语记忆分别下降的患者比例为38.5%和4s.1%。与耳上入路相比，耳前入路对言语记忆的影响更大（p = 0.041）。15例（51.7%）患者在上象限检测到最小视野缺损。同时，在任何情况下，视野缺损均未延伸至下象限以及上象限受影响20°范围内。
骨孔显微手术颞下SAH是治疗耐药性TLE的有效手术方法。它涉及上象限20°范围内视野丧失的风险极小。与耳前入路相比，耳上入路可降低上象限偏盲的发生率，并与较低的言语记忆损害风险相关。
