Wainberg Ricardo C, Martins William Alves, de Oliveira Francine H, Paglioli Eliseu, Paganin Ricardo, Soder Ricardo, Paglioli Rafael, Frigeri Thomas M, Baldisseroto Matteo, Palmini André
Service of Neurosurgery, Hospital São Lucas, Porto Alegre, Brazil.
Porto Alegre Epilepsy Surgery Program, Neurology and Neurosurgery Services, Hospital São Lucas, Pontifícia Universidade Católica Do Rio Grande Do Sul, Porto Alegre, Brazil.
Epilepsia. 2025 Jan;66(1):279-287. doi: 10.1111/epi.18162. Epub 2024 Nov 6.
This study was undertaken to analyze the histology underlying increased T2 signal intensity (iT2SI) in anterior temporal lobe white matter (aTLWM) epilepsy due to hippocampal sclerosis (TLE/HS).
Twenty-three patients were included: 16 with increased T2 signal in the aTLWM and seven with HS only. Magnetic resonance imaging (MRI) findings were consistent across two neuroradiologists (kappa = .89, p < .001). Quantification of neuronal cells, astrocytes, oligodendrocytes, and vacuolization in the white matter of temporal lobe specimens was performed by immunohistochemistry (neuronal nuclear antigen, glial fibrillary acidic protein, oligodendrocyte transcription factor, and basic myelin protein, respectively). Surgical specimens from TLE/HS patients with and without iT2SI in the aTLWM were compared. Samples of aTLWM were divided into three groups, according to MRI features: G1 = samples of iT2SI, G2 = samples with normal T2 signal intensity from patients without white matter imaging abnormalities, and G3 = samples with normal T2 signal intensity adjacent to areas with iT2SI.
Patients with increased T2 signal had a significantly younger age at epilepsy onset (p < .035). Histological analysis revealed a higher percentage of vacuolar area in these patients (p < .004) along with a lower number of ectopic neurons (p = .042). No significant differences were found in astrocyte or oligodendrocyte counts among groups.
A higher proportion of vacuoles in regions with iT2SI may be the histopathologic substrate of this signal alteration in the white matter of the temporal lobe in patients with TLE/HS. This method of quantifying vacuoles using digital image analysis proved reliable and cost-effective.
本研究旨在分析海马硬化所致颞叶内侧癫痫（TLE/HS）患者颞叶前部白质（aTLWM）T2信号强度增加（iT2SI）的组织学基础。
纳入23例患者，其中16例aTLWM的T2信号增加，7例仅有海马硬化。两名神经放射科医生对磁共振成像（MRI）结果的判断一致（kappa = 0.89，p < 0.001）。通过免疫组织化学方法（分别采用神经元核抗原、胶质纤维酸性蛋白、少突胶质细胞转录因子和碱性髓鞘蛋白）对颞叶标本白质中的神经元细胞、星形胶质细胞、少突胶质细胞和空泡化进行定量分析。比较了aTLWM有和没有iT2SI的TLE/HS患者的手术标本。根据MRI特征，将aTLWM样本分为三组：G1 = iT2SI样本，G2 = 无白质成像异常患者的T2信号强度正常的样本，G3 = iT2SI区域相邻的T2信号强度正常的样本。
T2信号增加的患者癫痫发作起始年龄显著更小（p < 0.035）。组织学分析显示，这些患者的空泡区域百分比更高（p < 0.004），而异位神经元数量更少（p = 0.042）。各组间星形胶质细胞或少突胶质细胞计数无显著差异。
iT2SI区域中较高比例的空泡可能是TLE/HS患者颞叶白质这种信号改变的组织病理学基础。这种使用数字图像分析定量空泡的方法被证明是可靠且具有成本效益的。
