Collateral brain damage, a potential source of cognitive impairment after selective surgery for control of mesial temporal lobe epilepsy
Collateral brain damage, a potential source of cognitive impairment after selective surgery for control of mesial temporal lobe epilepsy
复制标题
附带脑损伤是控制内侧颞叶癫痫的选择性手术后认知障碍的潜在来源
DOI：
10.1136/jnnp.2003.013706
复制
发表时间：
2004
期刊：
影响因子：
--
通讯作者：
J. Schramm
中科院分区：
文献类型：
--
作者：
C. Helmstaedter;D. Van Roost;H. Clusmann;H. Urbach;C. Elger;J. Schramm
背景资料：颞叶癫痫的高选择性癫痫手术旨在以比标准整体切除术更低的认知风险实现癫痫发作自由，但也存在手术入路导致附带皮质损伤的风险。目的：探讨选择性杏仁核-小脑顶切除术（SAH）对大脑皮质的损害。方法：对34例癫痫患者进行回顾性分析。他们被随机分配到使用侧裂入路（9例左侧/10例右侧）或经皮质手术入路（5例左侧/10例右侧）的SAH组。邻近入路的术后MRI信号强度变化与连续单词和设计列表学习的表现变化相关。结果如下：语言学习和识别记忆的丧失与信号强度变化呈正相关，与切除侧、手术入路或近中切除范围无关。左侧手术后巩固/提取（记忆）的损失更大。设计学习的损失与右侧手术和信号强度变化有关。癫痫发作结局（85%无癫痫发作）不因手术侧或手术类型而异。结论：邻近手术入路的皮质组织的附带损伤有助于SAH后的术后语言和图形记忆结果。控制附带损害可能会澄清不同手术中心报道的SAH后有争议的记忆结果。
Background: Highly selective epilepsy surgery in temporal lobe epilepsy is intended to achieve seizure freedom at a lower cognitive risk than standard en bloc resections, but bears the risk of collateral cortical damage resulting from the surgical approach. Objective: To investigate cortical damage associated with selective amygdalo-hippocampectomy (SAH). Methods: 34 epileptic patients were evaluated. They were randomly assigned to SAH using either a sylvian (9 left/10 right) or a transcortical surgical approach (5 left/10 right). Postoperative MRI signal intensity changes adjacent to the approach were correlated with performance changes in serial word and design list learning. Results: Losses in verbal learning and recognition memory were positively related to signal intensity changes, independent of the side of the resection, the surgical approach, or the extent of the mesial resection. Losses in consolidation/retrieval (memory) were greater after left sided surgery. Losses in design learning were related to right sided surgery and signal intensity changes. Seizure outcome (85% seizure-free) did not differ depending on the side or type of surgery. Conclusions: Collateral damage to cortical tissues adjacent to the surgical approach contributes to postoperative verbal and figural memory outcome after SAH. Controlling for collateral damage may clarify the controversial memory outcomes after SAH reported by different surgical centres.