Arruda F, Cendes F, Andermann F, Dubeau F, Villemure J G, Jones-Gotman M, Poulin N, Arnold D L, Olivier A
Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Quebec, Canada.
Ann Neurol. 1996 Sep;40(3):446-50. doi: 10.1002/ana.410400314.
We studied 74 consecutive patients with temporal lobe epilepsy who were treated surgically and in whom the volumes of mesial temporal structures were determined preoperatively by magnetic resonance imaging. We divided the patients into three groups according to the volumetric findings: unilateral (63.5% of the patients), bilateral (23%), or no atrophy (13.5%) of the amygdala-hippocampal formation. Two distinct surgical approaches were used: selective amygdalohippocampectomy (n = 37) or anterior temporal lobe resection (n = 37). Outcome was assessed at least 1 year after surgery, according to Engel's modified classification. Patients with unilateral mesial temporal atrophy had significantly better results compared with the other two groups (p < 0.001): We found excellent results (class I or II outcome) in 93.6% of the patients with unilateral atrophy, in 61.7% of those with bilateral atrophy, and in 50% of the group with no significant atrophy of mesial temporal structures. The two different surgical techniques were equally effective, regardless of the pattern of atrophy. In conclusion, magnetic resonance volumetric studies in temporal lobe epilepsy proved to be an important preoperative prognostic tool for surgical treatment, but they did not provide guidance for selecting one surgical approach compared to the other.
我们研究了74例接受手术治疗的颞叶癫痫患者，这些患者术前通过磁共振成像测定了内侧颞叶结构的体积。我们根据体积测量结果将患者分为三组：杏仁核-海马结构单侧萎缩（占患者的63.5%）、双侧萎缩（23%）或无萎缩（13.5%）。采用了两种不同的手术方法：选择性杏仁核-海马切除术（n = 37）或颞叶前部切除术（n = 37）。根据恩格尔改良分类法，在术后至少1年评估结果。与其他两组相比，单侧内侧颞叶萎缩的患者结果明显更好（p < 0.001）：我们发现单侧萎缩患者中93.6%的结果为优（I级或II级结果），双侧萎缩患者中61.7%的结果为优，内侧颞叶结构无明显萎缩组中50%的结果为优。无论萎缩模式如何，两种不同的手术技术效果相同。总之，颞叶癫痫的磁共振体积研究被证明是手术治疗重要的术前预后工具，但与另一种手术方法相比，它们并未为选择一种手术方法提供指导。
