Helmstaedter C, Gleibner U, Zentner J, Elger C E
University Hospital of Epileptology, Bonn, Germany.
Neuropsychologia. 1998 Apr;36(4):333-41. doi: 10.1016/s0028-3932(97)00118-8.
The present study investigated the effect of frontal lobe surgery on "cognitive functions", which have previously been shown to be discriminative in the evaluation of non-resected patients with frontal lobe epilepsy (FLE). The cognitive outcome was evaluated with particular consideration of the side (left/right), the site (lateral, orbital, mesial, premotor/SMA), the type of surgery (resections vs. resections plus multiple subpial transections; MST), and seizure outcome. The evaluation is based on 33 patients with left (n = 17) or right (n = 16) frontal surgery. Forty-five patients who underwent successful left (n = 21) or right (n = 24) temporal lobectomy served as controls. The neuropsychological examination covered speed/attention, motor sequencing/coordination, response maintenance/inhibition, short-term memory, and language. With the exception of short-term memory, the chosen tests were discriminative in determining preoperative frontal lobe dysfunctions but they did not differentiate patients with a different lateralization or localization of the frontal focus. At the 3 month follow-up examination, patients with temporal lobectomy had improved frontal functions, whereas patients with frontal lobe surgery showed a mild deterioration. Within the frontally resected group, completely seizure-free patients had significantly improved short-term memory. Further consideration of the side, site and the type of the frontal resection indicated that patients with premotor/SMA surgery and patients with precentral/central MST had additional impairment after surgery. Premotor/SMA resections led to a deterioration in response maintenance/inhibition and if performed left sided also to deteriorated language functions. The latter impairment could be clearly related to transient aphasia directly after surgery. Irrespective of pareses observed immediately after surgery, patients with MSTs of the precentral/central areas displayed additional problems in motor coordination at the follow-up examination. In this group the seizure outcome was also less favourable. In summing up, frontal lobe surgery does not cause any considerable additional impairment in the short-term follow-up. However, caution is recommended when surgery or MST affect functional relevant cortex (here the prefrontal/SMA and precentral/central area). Finally, a release of functions associated with frontal areas not affected by surgery is suggested, when seizures are successfully controlled by surgery.
本研究调查了额叶手术对“认知功能”的影响，此前研究表明，这些认知功能在评估未经手术的额叶癫痫（FLE）患者时具有鉴别意义。评估认知结果时特别考虑了手术侧（左/右）、部位（外侧、眶部、内侧、运动前区/辅助运动区）、手术类型（切除术与切除术加多处软膜下横切术；MST）以及癫痫发作结果。该评估基于33例接受左侧（n = 17）或右侧（n = 16）额叶手术的患者。45例成功接受左侧（n = 21）或右侧（n = 24）颞叶切除术的患者作为对照。神经心理学检查涵盖速度/注意力、运动序列/协调、反应维持/抑制、短期记忆和语言。除短期记忆外，所选测试在确定术前额叶功能障碍方面具有鉴别意义，但它们无法区分额叶病灶侧别或定位不同的患者。在3个月的随访检查中，颞叶切除术患者的额叶功能有所改善，而额叶手术患者则出现轻度恶化。在额叶切除组中，完全无癫痫发作的患者短期记忆有显著改善。进一步考虑额叶切除的侧别、部位和类型表明，运动前区/辅助运动区手术患者和中央前回/中央区MST患者术后有额外的功能损害。运动前区/辅助运动区切除术导致反应维持/抑制功能恶化，如果在左侧进行手术，还会导致语言功能恶化。后者的损害可能与术后直接出现的短暂性失语明显相关。无论术后立即观察到的瘫痪情况如何，中央前回/中央区MST患者在随访检查中均表现出运动协调方面的额外问题。在该组中，癫痫发作结果也不太理想。总之，额叶手术在短期随访中不会造成任何明显的额外损害。然而，当手术或MST影响功能相关皮层（此处为前额叶/辅助运动区和中央前回/中央区）时，建议谨慎操作。最后，当手术成功控制癫痫发作时，提示未受手术影响的额叶区域相关功能会得到释放。
