Visual Field Defects After Selective Amygdalohippocampectomy and Standard Temporal Lobectomy
Visual Field Defects After Selective Amygdalohippocampectomy and Standard Temporal Lobectomy
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DOI：
10.1097/wno.0b013e3181b41262
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发表时间：
2009-09-01
影响因子：
2.9
通讯作者：
Abou-Khalil, B. W.
中科院分区：
文献类型：
--
作者：
Mengesha, T.;Abu-Ata, M.;Abou-Khalil, B. W.
背景资料：选择性杏仁核切除术（细拉）越来越多地用于内侧颞叶癫痫和海马硬化患者。要确定是否视野缺损后细拉不太明显比标准颞叶切除术（StTL）后，我们回顾性分析术后定量视野后2 procedures.Methods：汉弗莱视野分析后获得18例谁经历了细拉和33例谁经历了StTL。细拉通过颞中回经皮质入路进行，包括杏仁核、海马3 cm和海马旁回。视野模式偏差用于分析。我们认为一个缺陷的临床意义，如果有3个连续的坐标影响在5%的水平或2在1%level.Results：所有，但2的18例患者谁经历了细拉有同侧上级象限视野缺损对侧的手术。根据我们的标准，一名患者没有缺陷，一名患者有轻微缺陷，仅在同侧眼睛中达到显著性。平均缺陷主要影响垂直子午线附近的坐标，而水平子午线附近的点相对较少。33例接受StTL的患者中，除3例外，所有患者均存在同侧上级象限视野缺损。1例患者无缺陷; 2例患者的缺陷仅在一只眼睛中达到显著性。平均缺损涉及受影响象限的所有点，但垂直子午线附近也较大。在13个测试的视野坐标中，4个在同侧眼中受细拉影响显著较小，3个在对侧眼中受SelAH影响显著较小。接近水平子午线的坐标被细拉显著地保留。结论：细拉后视野缺损非常常见，但显著地低于StTL后。特别是，接近水平子午线的视野在细拉中相对空闲。
Background: Selective amygdalohippocampectomy (SelAH) is increasingly performed in patients with mesial temporal lobe epilepsy and hippocampal sclerosis. To determine whether visual field defects are less pronounced after SelAH than after standard temporal lobectomy (StTL), we retrospectively analyzed postoperative quantitative visual fields after the 2 procedures.Methods: Humphrey visual field analysis was obtained postoperatively in 18 patients who had undergone SelAH and in 33 patients who had undergone StTL. The SelAH was performed via a transcortical approach through the middle temporal gyrus and included the amygdala, 3 cm of the hippocampus, and the parahippocampal gyrus. The visual field pattern deviation was used for analysis. We considered a defect clinically significant if there were 3 contiguous coordinates affected at the 5% level or 2 at the 1% level.Results: All but 2 of 18 patients who had undergone SelAH had homonymous superior quadrantic visual field defects contralateral to the side of the surgery. One patient had no defects by our criteria, and one had a mild defect that reached significance only in the ipsilateral eye. The averaged defect affected mostly coordinates close to the vertical meridian with relative sparing of points close to the horizontal meridian. All but 3 of the 33 patients who had undergone StTL had homonymous superior quadrantic visual field defects. One patient had no defects; 2 had defects that reached significance in only one eye. The averaged defect involved all points in the affected quadrant, but was also greater near the vertical meridian. Of 13 tested visual field coordinates, 4 were significantly less affected by SelAH in the ipsilateral eye and 3 in the contralateral eye. The coordinates close to the horizontal meridian were significantly spared by SelAH.Conclusions: Visual field defects are very common after SelAH but are significantly less pronounced than after StTL. In particular, the visual field close to the horizontal meridian is relatively spared in SelAH.