BILATERAL HIPPOCAMPAL ATROPHY IN MEDIAL TEMPORAL-LOBE EPILEPSY
BILATERAL HIPPOCAMPAL ATROPHY IN MEDIAL TEMPORAL-LOBE EPILEPSY
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DOI：
10.1111/j.1528-1157.1995.tb01634.x
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发表时间：
1995-09-01
期刊：
影响因子：
5.6
通讯作者：
SPENCER, DD
中科院分区：
文献类型：
--
作者：
KING, D;SPENCER, SS;SPENCER, DD
海马萎缩的定量证据与癫痫发作部位、海马神经元丢失和切除后癫痫缓解相关。大多数研究已经使用左右海马值之间的比率或差异来量化海马萎缩。然而，双侧海马萎缩可能仍然未被这些技术检测到。为了评估双侧海马萎缩的频率和意义，我们研究了53例颞叶切除术患者的绝对海马体积，这些患者术前接受了颅内脑电图记录。冠状面图像垂直于海马的纵轴。萎缩定义为海马后部1.5 cm体积低于对照值>2 SD。53例患者中有5例（9%）双侧海马萎缩;其中4例未通过比率检测到。所有5例患者均在发作侧进行了手术; 4例患者2年以上无复发。这些结果表明：（a）内侧颞叶硬化可以存在于双侧，并且可能未被海马比率或差异测量检测到;（B）需要绝对海马体积值以及比率来检测所有双侧海马萎缩的患者;和（c）颞叶切除术在双侧海马萎缩的患者中不是禁忌症，但成功取决于主要发作侧的脑电图记录。
Quantitative evidence of hippocampal atrophy has been correlated with site of seizure onset, hippocampal neuronal loss, and seizure relief after resection. Most studies have quantified hippocampal atrophy using ratios or differences between right and left hippocampal values. However, bilateral hippocampal atrophy may remain undetected by these techniques. To assess the frequency and implications of bilateral hippocampal atrophy, we studied absolute hippocampal volumes in 53 temporal lobectomy patients who had undergone intracranial electroencephalogram recordings preoperatively. Coronal images were constructed perpendicular to the longitudinal axis of the hippocampus. Atrophy was defined as >2 SD below control values in the volume of the posterior 1.5 cm of the hippocampus, Five of 53 patients (9%) had bilateral hippocampal atrophy; four of these cases were undetected by ratios. Surgery was performed on the side of ictal onset in all five patients; four have been seizure-free for >2 years. These results suggest that (a) mesial temporal sclerosis can be present bilaterally and may go undetected by hippocampal ratio or difference measures; (b) absolute hippocampal volume values as well as ratios are needed to detect all patients with bilateral hippocampal atrophy; and (c) temporal lobectomy is not contraindicated in patients with bilateral hippocampal atrophy, but success depends on electroencephalographic documentation of the side of predominant ictal onset.