Epilepsy surgery outcomes in temporal lobe epilepsy with a normal MRI.
Epilepsy surgery outcomes in temporal lobe epilepsy with a normal MRI.
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DOI：
10.1111/j.1528-1167.2009.02079.x
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发表时间：
2009-09
期刊：
影响因子：
5.6
通讯作者：
Worrell GA
中科院分区：
文献类型：
--
作者：
Bell ML;Rao S;So EL;Trenerry M;Kazemi N;Stead SM;Cascino G;Marsh R;Meyer FB;Watson RE;Giannini C;Worrell GA
通过非病灶性磁共振成像（MRI）确定前颞叶切除术治疗难治性颞叶癫痫患者的长期疗效。我们确定了一个回顾性队列的44例患者的非病变现代“癫痫发作协议”的MRI谁接受前颞叶切除术治疗医学难治性部分癫痫。Kaplan-Meyer生存分析确定术后无癫痫发作。对40例随访时间>1年的患者进行单因素分析，探讨与手术效果良好潜在相关的无创性术前诊断因素。在60%（24/40）的患者中观察到Engel I级结局（无致残性癫痫发作）。与Engel I级结局相关的术前因素为：（1）对侧或颞外发作间期癫痫样放电缺失，（2）减影发作单光子发射计算机断层扫描（SPECT）与MRI共配准（SISCOM）异常定位于切除部位，（3）与切除一致的内侧颞叶轻微非特异性MRI表现。在精心挑选的颞叶癫痫患者和非病变MRI，前颞叶切除术往往可以使患者无致残性癫痫发作。这种有利的手术成功率可能是由于在非病灶性MRI患者中检测到一致的异常，表明单侧颞叶癫痫。
To determine the long-term efficacy of anterior temporal lobectomy for medically refractory temporal lobe epilepsy in patients with nonlesional magnetic resonance imaging (MRI). We identified a retrospective cohort of 44 patients with a nonlesional modern “seizure protocol” MRI who underwent anterior temporal lobectomy for treatment of medically refractory partial epilepsy. Postoperative seizure freedom was determined by Kaplan-Meyer survival analysis. Noninvasive preoperative diagnostic factors potentially associated with excellent surgical outcome were examined by univariate analysis in the 40 patients with follow-up of >1 year. Engel class I outcomes (free of disabling seizures) were observed in 60% (24 of 40) patients. Preoperative factors associated with Engel class I outcome were: (1) absence of contralateral or extratemporal interictal epileptiform discharges, (2) subtraction ictal single photon emission computed tomography (SPECT) Coregistered to MRI (SISCOM) abnormality localized to the resection site, and (3) subtle nonspecific MRI findings in the mesial temporal lobe concordant to the resection. In carefully selected patients with temporal lobe epilepsy and a nonlesional MRI, anterior temporal lobectomy can often render patients free of disabling seizures. This favorable rate of surgical success is likely due to the detection of concordant abnormalities that indicate unilateral temporal lobe epilepsy in patients with nonlesional MRI.
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