Functional anterior temporal lobectomy for temporal lobe epilepsy: from anatomical resection to functional disconnection.

IF 3.5 2区 医学 Q1 CLINICAL NEUROLOGY
Yong Liu, Qiang Meng, Yutao Ren, Hao Wu, Huanfa Li, Hui Li, Anqing Li, Haohao Cui, Xiaobo Ye, Shan Dong, Xiaofang Liu, Changwang Du, Hua Zhang
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Abstract

Objective: Although anterior temporal lobectomy (ATL) has the highest efficacy for temporal lobe epilepsy (TLE), there is currently a trend toward performing minimally invasive surgery (MIS) for TLE. However, the MIS methods, such as laser thermocoagulation, have been used at the expense of efficacy. Functional ATL (FATL), which involves functional disconnection instead of anatomical resection and was designed by the authors, resolves this problem. This study aimed to evaluate seizure outcomes of FATL as an MIS for TLE.

Methods: A consecutive case series of FATLs for ATL was conducted between 2020 and 2022. FATL was scheduled after standard presurgical evaluations of TLE and applied the same criteria as standard ATL. Seizure outcomes were categorized by Engel classifications, with at least 2 years of follow-up.

Results: Forty-nine patients with TLE who underwent FATL were included in the case series. The mean follow-up duration was 31.9 (range 24-42) months. Freedom from disabling seizures (Engel class I) occurred in 36 patients (73.5%) and significant improvement (Engel class I-II) occurred in 44 (89.8%) after surgery. The rate of complete freedom from all seizures (Engel class Ia) was 77.6% at 1 year after surgery and 69.4% at 2 years. No deaths or permanent morbidities after FATL were recorded. The complication rate was 2.0%.

Conclusions: FATL incorporates a change from anatomical resection to functional disconnection without brain shift. As a keyhole surgery, the FATL incision is barely visible, with a better cosmetic appearance than ATL. FATL has the MIS quality as well as excellent seizure outcomes similar to those of ATL.

功能性颞叶前切除术治疗颞叶癫痫:从解剖切除到功能断开。
目的:虽然颞叶前切除术(ATL)治疗颞叶癫痫(TLE)的疗效最高,但目前对颞叶癫痫进行微创手术(MIS)是一种趋势。然而,MIS方法,如激光热凝,已被使用,以牺牲疗效为代价。功能性ATL (FATL)解决了这一问题,作者设计了功能断开而不是解剖切除的ATL。本研究旨在评估FATL作为TLE的MIS的癫痫发作结果。方法:在2020年至2022年期间对ATL进行连续的fatl病例系列。在TLE的标准术前评估后安排FATL,并应用与标准ATL相同的标准。癫痫发作结果按Engel分类,随访至少2年。结果:49例TLE患者行FATL纳入病例系列。平均随访时间为31.9个月(24-42个月)。36例(73.5%)患者术后无致残性癫痫发作(Engel I级),44例(89.8%)患者术后有显著改善(Engel I- ii级)。术后1年和2年患者癫痫完全缓解率分别为77.6%和69.4%。FATL后无死亡或永久性发病记录。并发症发生率为2.0%。结论:FATL包含了从解剖切除到功能断开的变化,没有脑转移。作为一种锁眼手术,FATL切口几乎不可见,比ATL具有更好的美容外观。FATL具有MIS质量和与ATL相似的优异的癫痫发作结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of neurosurgery
Journal of neurosurgery 医学-临床神经学
CiteScore
7.20
自引率
7.30%
发文量
1003
审稿时长
1 months
期刊介绍: The Journal of Neurosurgery, Journal of Neurosurgery: Spine, Journal of Neurosurgery: Pediatrics, and Neurosurgical Focus are devoted to the publication of original works relating primarily to neurosurgery, including studies in clinical neurophysiology, organic neurology, ophthalmology, radiology, pathology, and molecular biology. The Editors and Editorial Boards encourage submission of clinical and laboratory studies. Other manuscripts accepted for review include technical notes on instruments or equipment that are innovative or useful to clinicians and researchers in the field of neuroscience; papers describing unusual cases; manuscripts on historical persons or events related to neurosurgery; and in Neurosurgical Focus, occasional reviews. Letters to the Editor commenting on articles recently published in the Journal of Neurosurgery, Journal of Neurosurgery: Spine, and Journal of Neurosurgery: Pediatrics are welcome.
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