Does resection of the medial temporal lobe improve the outcome of temporal lobe epilepsy surgery?
Does resection of the medial temporal lobe improve the outcome of temporal lobe epilepsy surgery?
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DOI：
10.1111/j.1528-1167.2006.00958.x
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发表时间：
2007-03-01
期刊：
影响因子：
5.6
通讯作者：
Cendes, Fernando
中科院分区：
文献类型：
--
作者：
Bonilha, Leonardo;Yasuda, Clarissa Lin;Cendes, Fernando
目的：手术切除海马体是耐药的内侧颞叶癫痫(MTLE)患者的标准护理。该手术的成功率类似于75%，但一些患者手术后未能实现癫痫控制的原因仍然难以解释。本研究旨在探讨除海马体外，内侧颞叶结构切除是否会影响MTLE患者的手术结果。方法：我们对接受前内侧颞叶切除的MTLE患者术后的高分辨率MRI进行了体素统计分析。我们应用了每个患者的切除地图到一组共同的空间坐标的成本函数变换，并分析了组织学上不同的内侧颞叶皮质部分对手术结果的贡献。我们还进行了手术结果与颞叶的体素映射。结果：我们观察到海马区切除的程度与更好的结果相关。然而，如果同时切除内侧颞叶，尤其是内侧嗅觉皮质，则术后癫痫控制率更高。结论：根据这一发现，在切除海马体的基础上，调整手术方式，以包括内侧嗅觉皮质的切除，可提高MTLE的外科治疗效率。
Purpose: Surgical removal of the hippocampus is the standard of care of patients with drug-resistant medial temporal lobe epilepsy (MTLE). The procedure carries a success rate of similar to 75%, but the reasons that some patients fail to achieve seizure control after surgery remain inexplicable. The question of whether the resection of medial temporal lobe structures in addition to the hippocampus would influence the surgical outcome in patients with MTLE was examined.Methods: We conducted voxel-based statistical analyses of postoperative high-resolution MRI of MTLE patients who underwent anteromedial temporal resection. We applied a cost function transformation of the resection maps for each patient to a common set of spatial coordinates, and we analyzed the contribution of histologically distinct segments of the medial temporal lobe cortex to the surgical outcome. We also performed a voxel-wise mapping of surgical outcome to the temporal lobe.Results: We observed that the extent of hippocampal removal was associated with better outcomes. However, when the resection of the hippocampus was combined with the resection of the medial temporal lobe, specifically the entorhinal cortex, a greater likelihood of higher seizure control after surgery was found.Conclusions: Based on this finding, it is possible that the efficiency of the surgical treatment of MTLE can be improved by adjusting the procedure to include the resection of the entorhinal cortex, in addition to the resection of the hippocampus.