Neuropsychological outcome after selective amygdalohippocampectomy with transsylvian versus transcortical approach: A randomized prospective clinical trial of surgery for temporal lobe epilepsy
Neuropsychological outcome after selective amygdalohippocampectomy with transsylvian versus transcortical approach: A randomized prospective clinical trial of surgery for temporal lobe epilepsy
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DOI：
10.1111/j.0013-9580.2004.54003.x
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发表时间：
2004-07-01
期刊：
影响因子：
5.6
通讯作者：
Helmstaedter, C
中科院分区：
文献类型：
--
作者：
Lutz, MT;Clusmann, H;Helmstaedter, C
目的：选择性杏仁核切除术（SAH）是治疗难治性内侧颞叶癫痫患者的一种手术治疗选择。与标准的前颞叶切除术相比，尽管在选定的患者中获得了相同的癫痫发作结局，但切除未受影响的组织有限。在SAH中，内侧结构可以通过不同的路径进入，经侧裂入路和经皮质入路。关于术后认知结果的优点或缺点仍然是一个争论的问题。方法：80例随机患者纳入分析。41例患者采用经侧裂入路，39例患者采用经皮质入路。所有患者接受全面的语言和非语言记忆，注意力和执行功能的神经心理学测试前和6个月或1年后SAH.Results：75%的患者成为完全癫痫发作免费没有差异取决于所选择的方法。重复测量多变量方差分析（MANOVA）表明，认知结果后，这两种方法基本相同。唯一的例外是音素流畅性，这是显着改善后，经皮质，但不经侧裂SAH.Conclusions：结果表明，无论是手术方法可以选择独立的认知结果标准。经皮质SAH后音素流畅性的改善可能反映了癫痫手术后认知功能的选择性正常化，而额叶操作可能阻碍了经侧裂SAH后该功能的恢复。
Purpose: Selective amygdalohippocampectomy (SAH) is a surgical treatment option for patients with medically intractable mesial temporal lobe epilepsy. In contrast to standard anterior temporal lobectomy, resection of unaffected tissue is limited, although it achieves equal seizure outcomes in selected patients. In SAH, the mesial structures can be approached by different routes, the transsylvian approach and the transcortical approach. Advantages or disadvantages with respect to postoperative cognitive outcome are still a matter of debate.Methods: Eighty randomized patients were included in the analyses. In 41 patients, the transsylvian approach, and in 39 patients, the transcortical approach was performed. All patients received comprehensive neuropsychological testing of verbal and nonverbal memory, attention, and executive functions before and 6 months or 1 year after SAH.Results: Seventy-five percent of patients became completely seizure free with no difference depending on the chosen approach. Repeated measures multivariate analysis of variance (MANOVA) showed that cognitive outcomes after both approaches were essentially the same. The only exception was phonemic fluency, which was significantly improved after transcortical but not after transsylvian SAH.Conclusions: The results indicate that either surgical approach can be chosen independent of cognitive outcome criteria. Improvement in phonemic fluency after transcortical SAH may reflect selective normalization of cognitive function after epilepsy surgery, whereas frontal lobe manipulation might have hindered recovery of this function after transsylvian SAH.