Hippocampal resection length and memory outcome in selective epilepsy surgery
Hippocampal resection length and memory outcome in selective epilepsy surgery
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DOI：
10.1136/jnnp.2010.240176
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发表时间：
2011-12-01
影响因子：
11
通讯作者：
Schramm, Johannes
中科院分区：
文献类型：
--
作者：
Helmstaedter, Christoph;Roeske, Sandra;Schramm, Johannes
目的颞叶癫痫外科治疗的选择性越来越高，以达到控制癫痫发作和获得最佳神经心理效果的目的。本研究评估选择性杏仁核切除术（SAH）后，近中切除长度是否对记忆结果有影响。因此，一个更大的SFB/TR 3/A1多中心随机试验癫痫发作的结果和内侧切除长度在颞叶surgery performed.Methods一个同质组67例选择性手术患者海马硬化作为唯一的病理被分配到一个短（2.5厘米，n=34）或长（3.5厘米，n=33）内侧切除。重复记忆评估和三维MRI数据集作为组内变量的依赖，和术中确定的切除长度（短/长），切除海马体积（小/大）和手术侧之间的组variables.Results切除长度没有显着影响癫痫发作或记忆结果。切除的海马体积也不影响癫痫发作的结果，但它确实使记忆结果的差异。切除较大的左侧海马体积后，语言学习和记忆的结果较差。图形的记忆结果是较差的切除体积在任一侧。解释数据表明，在SAH，近中切除长度和切除体积癫痫发作的结果没有差异性的影响。对记忆结果的研究结果最好的解释是，海马体积考虑到术前病理的程度，而切除长度没有。这表明非病理性功能组织的切除是SAH后记忆结果的基础。
Objective In temporal lobe epilepsy surgery, there is a trend towards becoming more selective in order to achieve seizure control with an optimal neuropsychological outcome. The present study evaluated whether mesial resection length matters for memory outcome after selective amygdalohippocampectomy (SAH). Therefore, a sub-analysis of the larger SFB/TR3/A1 multicentre randomised trial on seizure outcome and mesial resection length in temporal lobe surgery was performed.Methods A homogeneous group of 67 selectively operated patients with hippocampal sclerosis as the sole pathology were allocated to a short (2.5 cm, n=34) or a long (3.5 cm, n=33) mesial resection. Repeated memory assessment and three-dimensional MRI data sets served as dependent within group variables, and intraoperatively determined resection lengths (short/long), resected hippocampal volumes (small/large) and side of surgery were independent between group variables.Results Resection length did not have a significant effect on seizure or on memory outcome. The resected hippocampal volume also did not affect seizure outcome but it did make a difference with regard to memory outcome. Outcome in verbal learning and memory was poorer after resection of larger left hippocampal volumes. Figural memory outcome was poorer with larger resected volumes on either side.Interpretation The data indicate that in SAH, mesial resection length and resected volumes have no differential effect on seizure outcome. The findings on memory outcome are best explained by suggesting that hippocampal volumes take the degree of preoperative pathology into account whereas resection length does not. This suggests resection of non-pathological functional tissues as the basis for memory outcome after SAH.