Department of Neurosurgery, Osaka Metropolitan University, Graduate School of Medicine, Osaka, Japan.
Department of Neurosurgery, Osaka Metropolitan University, Graduate School of Medicine, Osaka, Japan; Department of Pediatric Neurosurgery, Osaka City General Hospital, Osaka, Japan.
Clin Neurol Neurosurg. 2024 Nov;246:108546. doi: 10.1016/j.clineuro.2024.108546. Epub 2024 Sep 10.
Surgical resections for lesions associated with intractable temporal lobe epilepsy (TLE) offers good seizure outcomes.However, the necessity of hippocampectomy in addition to lesionectomy is controversial, especially when the hippocampus is not involved by the lesion. Lesionectomy alone, preserving the hippocampus by an appropriate surgical approach, might offer good seizure outcomes while maintaining neurocognitive function. In the present study, the aims were to examine the surgical strategy for lesions associated with TLE and to present how to select surgical approaches to preserve the hippocampus.
A total of 22 consecutive lesion-associated TLE patients who underwent lesionectomy alone were retrospectively reviewed. The surgical approach, transsylvian, transorbital, subtemporal, supracerebellar transtentorial, or transcortical approach, was selected based on the location of the lesion. Postoperative seizure outcomes were classified by the Engel classification. Neurocognitive outcomes were assessed before and after surgery if possible. The pathology, the extent of resection, and lesion recurrence were reviewed.
The transsylvian approach was selected in six patients, the transorbital approach in one patient, the subtemporal approach in three patients, the supracerebellar transtentorial approach in five patients, and the transcortical approach in seven patients. Eighteen of 22 (81.8 %) patients achieved Engel's class I or II good seizure outcomes. No patients had neurocognitive deterioration after surgery. Twelve patients had various types of brain tumors, and ten patients had non-tumorous lesions. Gross total resection was achieved in 21 patients. All patients had no recurrence.
For patients with lesion-associated TLE, lesionectomy alone by the appropriate surgical approach offers satisfactory seizure outcomes while preserving hippocampus.
对于与难治性颞叶癫痫（TLE）相关的病变，手术切除可获得良好的癫痫发作结果。然而，除了病变切除术之外是否需要行海马切除术存在争议，尤其是当海马未被病变累及时。通过适当的手术方法保留海马的单纯病变切除术可能在保持神经认知功能的同时获得良好的癫痫发作结果。本研究旨在探讨与 TLE 相关的病变的手术策略，并介绍如何选择保留海马的手术方法。
回顾性分析了 22 例连续接受单纯病变切除术的病变相关 TLE 患者。根据病变的位置选择手术入路，包括经外侧裂、经眶、经颞下、经小脑幕上经小脑幕下入路或经皮质入路。术后癫痫发作结果根据 Engel 分类进行分类。如果可能，在术前和术后评估神经认知结果。回顾病理、切除范围和病变复发情况。
6 例患者选择经外侧裂入路，1 例患者选择经眶入路，3 例患者选择经颞下入路，5 例患者选择经小脑幕上经小脑幕下入路，7 例患者选择经皮质入路。22 例患者中的 18 例（81.8%）达到了 Engel 分级 I 或 II 的良好癫痫发作结果。术后无患者出现神经认知恶化。12 例患者患有各种类型的脑肿瘤，10 例患者患有非肿瘤性病变。21 例患者实现了大体全切除。所有患者均无复发。
对于病变相关 TLE 患者，采用适当的手术方法进行单纯病变切除术可在保留海马的同时获得满意的癫痫发作结果。
