Minimally invasive surgical approaches for temporal lobe epilepsy.
Minimally invasive surgical approaches for temporal lobe epilepsy.
复制标题
颞叶癫痫的微创手术方法。
DOI：
10.1016/j.yebeh.2015.04.033
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发表时间：
2015-06
期刊：
影响因子：
--
通讯作者：
Vadera S
中科院分区：
文献类型：
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作者：
Chang EF;Englot DJ;Vadera S
手术可以是一种非常有效的治疗药物难治性颞叶癫痫（TLE）。微创切除术和非切除术治疗方案的出现引起了患者和提供者对癫痫手术的兴趣。然而，并非所有手术都适用于所有患者，考虑每种方法的癫痫发作结局至关重要，因为癫痫发作自由度是患者生活质量的最大预测因素。标准前颞叶切除术（ATL）仍然是治疗TLE的金标准，60-80%的患者无癫痫发作。它是目前唯一的切除性癫痫手术支持的随机对照试验，并提供了最好的保护，防止侧颞癫痫发作。选择性杏仁核campectomy技术保留了不同程度的外侧皮质和颞叶干，可以导致良好的癫痫发作的自由率，但复发性癫痫发作的风险似乎略高于ATL，目前尚不清楚是否神经心理学的结果与选择性的方法得到改善。立体定向放射外科提供了一个完全避免手术的机会，癫痫发作的结果正在调查中。立体定向激光热消融允许破坏内侧颞叶结构，并发症发生率低，恢复时间短，结局也在研究中。最后，虽然神经调节装置如响应性神经刺激、迷走神经刺激和脑深部电刺激在某些患者的治疗中发挥作用，但对于那些不适合切除或消融的患者，这些仍然是姑息性手术，因为完全癫痫发作的自由率很低。进一步开发和研究既有和新的手术治疗TLE的策略将是至关重要的，因为这种疾病的重大负担。
Surgery can be a highly effective treatment for medically refractory temporal lobe epilepsy (TLE). The emergence of minimally invasive resective and nonresective treatment options has led to interest in epilepsy surgery among patients and providers. Nevertheless, not all procedures are appropriate for all patients, and it is critical to consider seizure outcomes with each of these approaches, as seizure freedom is the greatest predictor of patient quality of life. Standard anterior temporal lobectomy (ATL) remains the gold standard in the treatment of TLE, with seizure freedom resulting in 60–80% of patients. It is currently the only resective epilepsy surgery supported by randomized controlled trials and offers the best protection against lateral temporal seizure onset. Selective amygdalohippocampectomy techniques preserve the lateral cortex and temporal stem to varying degrees and can result in favorable rates of seizure freedom but the risk of recurrent seizures appears slightly greater than with ATL, and it is not clear whether neuropsychological outcomes are improved with selective approaches. Stereotactic radiosurgery presents an opportunity to avoid surgery altogether, with seizure outcomes now under investigation. Stereotactic laser thermo-ablation allows destruction of the mesial temporal structures with low complication rates and minimal recovery time, and outcomes are also under study. Finally, while neuromodulatory devices such as responsive neurostimulation, vagus nerve stimulation, and deep brain stimulation have a role in the treatment of certain patients, these remain palliative procedures for those who are not candidates for resection or ablation, as complete seizure freedom rates are low. Further development and investigation of both established and novel strategies for the surgical treatment of TLE will be critical moving forward, given the significant burden of this disease.