Zillgitt Andrew J, Mong Eric R, Manasseh Angelique M, Guider Hannah C, Baki Nour, Staudt Michael D
Department of Neurology, Corewell Health William Beaumont University Hospital Neuroscience Center, Adult Comprehensive Epilepsy Center, Royal Oak, Michigan, USA.
Department of Neurosurgery, Corewell Health William Beaumont University Hospital Neuroscience Center, Royal Oak, Michigan, USA.
Epilepsia Open. 2024 Dec;9(6):2395-2407. doi: 10.1002/epi4.13063. Epub 2024 Oct 7.
Temporal lobe encephaloceles (TLEN) have been implicated as a cause of temporal lobe epilepsy (TLE), the treatment which is primarily surgical; however, there is no clear consensus on the optimal surgical approach, because it is unclear whether TLE related to TLEN can be addressed by a restricted encephalocele resection or if a more extensive resection is required. The aim of the current article is to report the clinical and electrophysiological profile of patients with TLE secondary to TLEN who underwent stereotactic electroencephalography (SEEG) implantation to identify the epileptogenic network.
A retrospective review was performed of patients with TLE related to TLEN who underwent SEEG implantation. Medical charts were reviewed for demographic data, the results of noninvasive and invasive investigations, and operative details. Surgical outcomes were based on Engel classification with at least 6 months follow-up.
Nine patients were identified. The mean age at epilepsy onset was 28 years (range, 15-41 years), and 7/9 patients were female. Scalp EEG revealed interictal epileptiform activity most often maximum in the frontotemporal and/or temporal regions. A discrete TLEN was often not identified on initial imaging, but was identified during re-review or at the time of surgery. Seizure onset zones during SEEG were localized to the mesial temporal structures, the temporal pole, or both. One patient became seizure-free following SEEG and another refused further surgery. Of the 7 patients who underwent epilepsy surgery, 5/7 underwent an anterior temporal lobectomy-surgical outcomes were favorable, with 5/7 achieving Engel I outcomes.
Invasive SEEG monitoring demonstrated ictal onsets may not be restricted to the TLEN, and often the temporal pole and mesial structures are involved at seizure onset. Ictal propagation patterns vary significantly, which may be related to the underlying pathology and explain the variability in semiology. These findings may inform surgical treatment options.
Temporal lobe encephaloceles can cause intractable epilepsy, although their presence may be missed on routine imaging. The management of encephaloceles is primarily surgical; however, the optimal surgical approach can be unclear. Invasive monitoring with SEEG may help characterize the epileptogenic network and result in more optimal surgical outcomes.
颞叶脑膨出（TLEN）被认为是颞叶癫痫（TLE）的病因之一，其治疗主要是手术治疗；然而，对于最佳手术方法尚无明确共识，因为尚不清楚与TLEN相关的TLE能否通过有限的脑膨出切除术解决，还是需要更广泛的切除术。本文的目的是报告继发于TLEN的TLE患者接受立体定向脑电图（SEEG）植入以确定癫痫发作网络的临床和电生理特征。
对接受SEEG植入的与TLEN相关的TLE患者进行回顾性研究。查阅病历以获取人口统计学数据、非侵入性和侵入性检查结果以及手术细节。手术结果基于Engel分类，随访至少6个月。
共确定9例患者。癫痫发作的平均年龄为28岁（范围15 - 41岁），9例中有7例为女性。头皮脑电图显示发作间期癫痫样活动最常在额颞部和/或颞部区域最为明显。最初的影像学检查通常未发现离散的TLEN，但在复查时或手术时发现。SEEG期间的癫痫发作起始区定位于颞叶内侧结构、颞极或两者。1例患者在SEEG后无癫痫发作，另1例拒绝进一步手术。在接受癫痫手术的7例患者中，7例中有5例行前颞叶切除术，手术效果良好，7例中有5例达到Engel I级结果。
侵入性SEEG监测表明发作起始可能不限于TLEN，癫痫发作起始时颞极和内侧结构常受累。发作期传播模式差异很大，这可能与潜在病理有关，并解释了症状学的变异性。这些发现可能为手术治疗选择提供参考。
颞叶脑膨出可导致难治性癫痫，尽管在常规影像学检查中可能遗漏其存在。脑膨出主要通过手术治疗；然而，最佳手术方法可能不明确。SEEG的侵入性监测可能有助于明确癫痫发作网络并带来更优的手术效果。
