Resection of piriform cortex predicts seizure freedom in temporal lobe epilepsy.
Resection of piriform cortex predicts seizure freedom in temporal lobe epilepsy.
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DOI：
10.1002/acn3.51263
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发表时间：
2021-01
影响因子：
5.3
通讯作者：
Vatter H
中科院分区：
文献类型：
--
作者：
Borger V;Schneider M;Taube J;Potthoff AL;Keil VC;Hamed M;Aydin G;Ilic I;Solymosi L;Elger CE;Güresir E;Fimmers R;Schuss P;Helmstaedter C;Surges R;Vatter H
经西西里选择性杏仁核-海马区切除术(TsSAHE)是公认的治疗耐药内侧颞叶癫痫(MTLE)的手术方法。虽然约70%的患者术后癫痫发作缓解，但仍有相当数量的患者持续癫痫发作。这可能部分是由于不同靶区切除程度不同所致。在这项研究中，我们分析了切除海马体、杏仁核和梨状皮质的比例与术后癫痫发作结果的关系。2012至2017年间，在作者所在机构接受TSAHE治疗的103名MTLE患者中，有82人被纳入分析。以切除的海马区、杏仁核和颞梨状皮质作为TSAHE的靶结构，对其进行体积测量，并按国际抗癫痫联盟(ILAE)1级和不良(ILAE 2-6级)癫痫发作结果进行分层。癫痫预后好的患者切除梨状皮质体积的比例明显高于癫痫预后不良的患者(中位切除比例体积分别为51%(IQR42~61)和13(IQR11~18)，P=0.0001)。海马区和杏仁体的切除比例在这些组中没有显著差异(海马区：81%(IQR 73-88)比80%(IQR 74-92)(P=0.70)；杏仁核：100%(IQR 100-100)比100%(IQR 100-100)(P=0.07))。这些结果强烈表明，颞叶梨状皮质是实现TSAHE后癫痫自由的关键靶点切除体积。
Transsylvian selective amygdalo‐hippocampectomy (tsSAHE) represents a generally recognized surgical procedure for drug‐resistant mesial temporal lobe epilepsy (mTLE). Although postoperative seizure freedom can be achieved in about 70% of tsSAHE, there is a considerable amount of patients with persisting postoperative seizures. This might partly be explained by differing extents of resection of various tsSAHE target volumes. In this study we analyzed the resected proportions of hippocampus, amygdala as well as piriform cortex in regard of postoperative seizure outcome. Between 2012 and 2017, 82 of 103 patients with mTLE who underwent tsSAHE at the authors’ institution were included in the analysis. Resected proportions of hippocampus, amygdala and temporal piriform cortex as target structures of tsSAHE were volumetrically assessed and stratified according to favorable (International League Against Epilepsy (ILAE) class 1) and unfavorable (ILAE class 2–6) seizure outcome. Patients with favorable seizure outcome revealed a significantly larger proportion of resected temporal piriform cortex volumes compared to patients with unfavorable seizure outcome (median resected proportional volumes were 51% (IQR 42–61) versus (vs.) 13 (IQR 11–18), P = 0.0001). Resected proportions of hippocampus and amygdala did not significantly differ for these groups (hippocampus: 81% (IQR 73–88) vs. 80% (IQR 74–92) (P = 0.7); amygdala: 100% (IQR 100–100) vs. 100% (IQR 100–100) (P = 0.7)). These results strongly suggest temporal piriform cortex to constitute a key target resection volume to achieve seizure freedom following tsSAHE.
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