Department of Neurology, Mayo Clinic, 200 1st St. SW, Rochester, MN, USA.
Department of Neurology, University of California, Davis, Sacramento, CA, USA.
Epilepsy Behav. 2023 Nov;148:109472. doi: 10.1016/j.yebeh.2023.109472. Epub 2023 Oct 20.
This study sought to evaluate the impact of surgical extent on seizure outcome in drug-resistant temporal lobe epilepsy (DR-TLE) with temporal encephaloceles (TE).
This was a single-institution retrospective study of patients who underwent surgery for DR-TLE with TE between January 2008 and December 2020. The impact of surgical extent on seizure outcome was evaluated. In a subset with dominant DR-TLE, the impact of surgical extent on neuropsychometric outcome was evaluated.
Thirty-four patients were identified (female, 56%; median age at surgery, 43 years). TE were frequently overlooked on initial magnetic resonance imaging (MRI), with encephaloceles only detected after repeat or expert re-review of MRI, additional multi-modal imaging, or intra-operatively in 31 (91%). Sixteen (47%) underwent limited resections, including encephalocele resection only (n = 5) and encephalocele resection with more extensive temporal corticectomy sparing the amygdala and hippocampus (n = 11). The remainder (n = 18, 53%) underwent standard anterior temporal lobectomy and amygdalohippocampectomy (ATLAH). Limited resection was performed more frequently on the left (12/17 vs. 4/17, p = 0.015). Twenty-seven patients (79%) had a favourable outcome (Engel I/II), and 17 (50%) were seizure-free at the last follow-up (median seizure-free survival of 27.3 months). There was no statistically significant difference in seizure-free outcomes between limited resection and ATLAH. In dominant DR-TLE, verbal memory decline was more likely after ATLAH than limited resection (3/4 vs. 0/9, p = 0.014).
Expert re-review of imaging and multi-modal advanced imaging improved TE identification. There was no statistical difference in seizure-free outcomes based on surgical extent. Preservation of verbal memory supports limited resection in dominant temporal cases.
本研究旨在评估颞叶脑膨出（TE）伴耐药性颞叶癫痫（DR-TLE）患者手术范围对癫痫发作结局的影响。
这是一项回顾性单中心研究，纳入了 2008 年 1 月至 2020 年 12 月期间因 DR-TLE 伴 TE 接受手术治疗的患者。评估了手术范围对癫痫发作结局的影响。在一组优势侧 DR-TLE 患者中，评估了手术范围对神经心理结局的影响。
共纳入 34 例患者（女性占 56%；手术时的中位年龄为 43 岁）。TE 在初始磁共振成像（MRI）上常被忽视，31 例（91%）患者在重复 MRI 检查或 MRI 专家重新评估、额外的多模态成像或术中才发现脑膨出；6 例（18%）患者仅行脑膨出切除术，11 例（32%）患者行脑膨出切除术联合颞叶皮质切除术，保留杏仁核和海马；18 例（53%）患者行标准的前颞叶切除术和杏仁核海马切除术（ATLAH）。17 例（50%）患者在最后一次随访时无癫痫发作（中位癫痫无发作生存时间为 27.3 个月）。18 例（53%）患者行标准的前颞叶切除术和杏仁核海马切除术（ATLAH）。在优势侧 DR-TLE 患者中，ATLAH 后言语记忆减退的发生率高于局限性切除术（3/4 比 0/9，p=0.014）。
对影像学和多模态高级影像学的专家重新评估提高了 TE 的检出率。手术范围对无癫痫发作结局无统计学差异。在优势侧颞叶病变中，保留言语记忆支持行局限性切除术。
