Wolf R L, Ivnik R J, Hirschorn K A, Sharbrough F W, Cascino G D, Marsh W R
Department of Neurology, Mayo Clinic and Foundation, Rochester, Minnesota.
J Neurosurg. 1993 Jul;79(1):76-83. doi: 10.3171/jns.1993.79.1.0076.
Decreased memory and learning efficiency may follow left temporal lobectomy. Debate exists as to whether the acquired deficit is related to the size of the surgical resection. This study addresses this question by comparing changes in cognitive performance to the extent of resection of both mesial temporal structures and lateral cortex. The authors retrospectively reviewed 47 right-handed patients who underwent left temporal lobectomy for medically intractable seizures. To examine the effects of the extent of mesial resection, the patients were divided into two groups: those with resection at the anterior 1 to 2 cm of mesial structures versus those with resection greater than 2 cm. To examine the effects of the extent of lateral cortical resection, patients were again divided into two groups: those with lateral cortex resections of 4 cm or less versus those with resections greater than 4 cm. Statistical analyses showed no difference in cognitive outcome between the groups defined by the extent of mesial resection. Likewise, no difference in cognitive outcome was seen between the groups defined by the extent of lateral cortical resection. Associated data analyses did, however, reveal a negative correlation of cognitive change with patient age at seizure onset. These results showed that the neurocognitive consequences of extended mesial resections were similar to those of limited mesial resections, and that the neurocognitive consequences of extended lateral cortical resections were similar to those of limited lateral cortical resections. The risk of cognitive impairment depends more on age at seizure onset than on the extent of mesial or lateral resection.
左侧颞叶切除术后可能会出现记忆力和学习效率下降的情况。关于所获得的缺陷是否与手术切除范围有关，目前存在争议。本研究通过比较认知表现的变化与内侧颞叶结构和外侧皮质的切除范围，来解决这个问题。作者回顾性分析了47例因药物难治性癫痫接受左侧颞叶切除术的右利手患者。为了研究内侧切除范围的影响，将患者分为两组：内侧结构前1至2厘米处切除的患者与切除范围大于2厘米的患者。为了研究外侧皮质切除范围的影响，患者再次分为两组：外侧皮质切除4厘米或以下的患者与切除范围大于4厘米的患者。统计分析表明，以内侧切除范围定义的组间认知结果无差异。同样，以外侧皮质切除范围定义的组间认知结果也无差异。然而，相关数据分析确实显示认知变化与癫痫发作起始时的患者年龄呈负相关。这些结果表明，扩大内侧切除的神经认知后果与有限内侧切除的后果相似，扩大外侧皮质切除的神经认知后果与有限外侧皮质切除的后果相似。认知障碍的风险更多地取决于癫痫发作起始时的年龄，而非内侧或外侧切除的范围。
