Eliashiv S D, Dewar S, Wainwright I, Engel J, Fried I
Division of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
Neurology. 1997 Mar;48(3):621-6. doi: 10.1212/wnl.48.3.621.
A follow-up study was conducted on 60 patients who had standard en bloc anterior temporal lobe resection, including mesio-temporal structures, as treatment for temporal lobe lesions associated with chronic, medically intractable seizures. Lesions were identified as glial tumors, hamartomas, or vascular malformations. Long-term outcome was assessed in terms of seizure frequency and certain psychosocial sequelae. Seizure onset occurred at an average age of 15 years (median = 13.5 years), and patients experienced seizures for an average of 13 years prior to surgery. The mean time of follow-up was 8.4 years post-surgery (median = 6 years). The Kaplan-Meier curve at median follow-up showed a seizure-free rate of 80%. Late seizure recurrence was documented for three patients; two had been seizure free for 10 years and one for 15 years after surgery before re-onset of seizures in the absence of tumor recurrence. A prolonged history of seizures prior to surgery was associated with a poorer seizure outcome (p = 0.06), suggesting that secondary epileptogenesis at sites distant to the lesion may develop with years of uncontrolled seizures. There was a low tumor recurrence rate of 3.3% (two cases). The psychosocial outcome was generally good, with 67% working or engaged in educational studies, and improvement noted in 59% of cases for one or more of the psychosocial factors investigated. This study confirms that anterior temporal lobe resection for temporal lesions associated with chronic seizures is a successful treatment with a high seizure-free rate following surgery and good psychosocial outcome.
对60例接受标准整块前颞叶切除术（包括颞叶内侧结构）以治疗与慢性药物难治性癫痫相关的颞叶病变的患者进行了一项随访研究。病变被确定为胶质瘤、错构瘤或血管畸形。根据癫痫发作频率和某些社会心理后遗症评估长期预后。癫痫发作开始的平均年龄为15岁（中位数 = 13.5岁），患者在手术前平均经历了13年的癫痫发作。术后平均随访时间为8.4年（中位数 = 6年）。中位随访期的Kaplan-Meier曲线显示无癫痫发作率为80%。记录到3例患者出现晚期癫痫复发；2例在术后10年无癫痫发作，1例在术后15年无癫痫发作，之后在无肿瘤复发的情况下再次发作。术前癫痫发作病史较长与癫痫发作预后较差相关（p = 0.06），这表明在远离病变部位的继发性癫痫发生可能随着多年未控制的癫痫发作而发展。肿瘤复发率较低，为3.3%（2例）。社会心理结局总体良好，67%的患者工作或参与教育学习，在调查的一个或多个社会心理因素方面，59%的病例有改善。这项研究证实，对于与慢性癫痫相关的颞叶病变，前颞叶切除术是一种成功的治疗方法，术后无癫痫发作率高，社会心理结局良好。
