Abstract：
Mesial temporal lobe epilepsy (mTLE) is an important cause of drug-resistant epilepsy (DRE) in adults and children. Traditionally, the surgical option of choice for mTLE includes a frontotemporal craniotomy and open resection of the anterior temporal cortex and mesial temporal structures. Although this technique is effective and durable, the neuropsychological morbidity resulting from temporal neocortical resections has resulted in the investigation of alternative approaches to resect the mesial temporal structures to achieve seizure freedom while minimizing postoperative cognitive deficits. Outcomes supporting the use of selective temporal resections have resulted in alternative approaches to directly access the mesial temporal structures via endoscopic approaches whose direct trajectory to the epileptogenic zone minimizes retraction, resection, and manipulation of surrounding cortex. The authors reviewed the utility of the endoscopic transmaxillary, endoscopic endonasal, endoscopic transorbital, and endoscopic supracerebellar transtentorial approaches for the treatment of drug-resistant mesial temporal lobe epilepsy. First, a review of the literature demonstrated the anatomical feasibility of each approach, including the limits of exposure provided by each trajectory. Next, clinical data assessing the safety and effectiveness of these techniques in the treatment of DRE were analyzed. An outline of the surgical techniques is provided to highlight the technical nuances of each approach. The direct access to mesial temporal structures and avoidance of lateral temporal manipulation makes endoscopic approaches promising alternatives to traditional methods for the treatment of DRE arising from the temporal pole and mesial temporal lobe. A dearth of literature outlining clinical outcomes, a need for qualified cosurgeons, and a lack of experience with endoscopic approaches remain major barriers to widespread application of the aforementioned techniques. Future studies are warranted to define the utility of these approaches moving forward.
摘要：
颞叶内侧癫痫（mTLE）是成人和儿童耐药性癫痫（DRE）的重要病因。传统上,mTLE的手术选择包括额颞部开颅术和颞前皮质和颞部内侧结构的开放性切除术.虽然这种技术是有效和持久的，颞部新皮质切除术导致的神经心理学发病率导致了对其他方法的研究，以切除颞部内侧结构，以实现癫痫发作的自由，同时最大程度地减少术后认知缺陷。支持使用选择性颞部切除的结果已导致通过内窥镜方法直接进入颞部结构的替代方法，其直接轨迹到癫痫发生区可最大程度地减少退缩。切除,以及对周围皮质的操纵。作者回顾了内镜下经上颌，鼻内镜,内镜经眶,内镜下经小脑幕上方法治疗耐药性颞叶内侧癫痫。首先,对文献的回顾证明了每种方法的解剖学可行性，包括每个轨迹提供的曝光限制。接下来,我们分析了评估这些技术治疗DRE的安全性和有效性的临床数据.提供了手术技术的概述，以突出每种方法的技术细微差别。直接进入内侧颞叶结构和避免外侧颞叶操纵使得内窥镜方法有望替代传统方法治疗由颞叶和内侧颞叶引起的DRE。缺乏概述临床结果的文献，需要合格的外科医生，缺乏内镜方法的经验仍然是上述技术广泛应用的主要障碍。未来的研究有必要确定这些方法的实用性。
