Foit Niels Alexander, Gau Karin, Rau Alexander, Urbach Horst, Beck Jürgen, Schulze-Bonhage Andreas
Department of Neurosurgery, Faculty of Medicine, Medical Center, University of Freiburg, 79106 Freiburg, Germany.
Neuroimaging of Epilepsy Laboratory, McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal, QC H3A 2B4, Canada.
Neurol Int. 2025 Mar 31;17(4):52. doi: 10.3390/neurolint17040052.
Temporal lobe epilepsy (TLE) constitutes the most common drug-refractory epilepsy syndrome. Tailored approaches are required, as TLE originates from extrahippocampal lesions in about one-quarter of surgical candidates. Despite high success rates in seizure control, concern persists regarding postoperative memory decline after lesionectomy. We investigated the associations between structural connectivity and postoperative memory performance in extrahippocampal TLE surgery.
In total, 55 patients (25 females, 30 males; mean age 29.8 ± 14.5 years; epilepsy duration 7.9 ± 10.5 years, 31 left, 24 right TLE) with extrahippocampal TLE undergoing hippocampal-sparing surgery were evaluated with standardized pre- and postoperative neuropsychological testing. Lesion volumes intersected with Human Connectome Project-derived tractography data were employed to assess the structural connectivity integrity via voxel-based and connectome-informed lesion-symptom mapping to identify cortical and white matter structures associated with cognitive outcomes.
Post-surgery, the widespread structural disconnection of several major white matter pathways was found, correlating with verbal memory and delayed recall. Additionally, the structural disconnection of the ipsilateral temporal lobe white matter was further associated with hippocampal atrophy.
Our study highlights the role of structural connectivity alterations in postoperative memory decline in extrahippocampal TLE surgery. These findings expand the traditional understanding of hippocampal integrity in memory function towards the importance of broader structural networks. Individualized, connectome-informed surgical approaches might protect neurocognitive function.
颞叶癫痫（TLE）是最常见的药物难治性癫痫综合征。由于约四分之一的手术候选者的TLE起源于海马体外病变，因此需要采取针对性的方法。尽管癫痫发作控制成功率很高，但对于病变切除术后的记忆衰退仍存在担忧。我们研究了海马体外TLE手术中结构连通性与术后记忆表现之间的关联。
总共55例患有海马体外TLE并接受保留海马手术的患者（25名女性，30名男性；平均年龄29.8±14.5岁；癫痫病程7.9±10.5年，31例左侧TLE，24例右侧TLE）接受了标准化的术前和术后神经心理学测试。将病变体积与人类连接组计划衍生的纤维束成像数据相交，通过基于体素的和连接组信息的病变-症状映射来评估结构连通性完整性，以识别与认知结果相关的皮质和白质结构。
手术后，发现几条主要白质通路广泛的结构断开，这与言语记忆和延迟回忆相关。此外，同侧颞叶白质的结构断开还与海马萎缩进一步相关。
我们的研究强调了结构连通性改变在海马体外TLE手术术后记忆衰退中的作用。这些发现扩展了对记忆功能中海马完整性的传统认识，使其认识到更广泛结构网络的重要性。个性化的、基于连接组信息的手术方法可能会保护神经认知功能。
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