Abstract：
The purpose of this study was to systematically examine three different surgical approaches in treating left medial temporal lobe epilepsy (mTLE) (viz., subtemporal selective amygdalohippocampectomy [subSAH], stereotactic laser amygdalohippocampotomy [SLAH], and anterior temporal lobectomy [ATL]), to determine which procedures are most favorable in terms of visual confrontation naming and seizure relief outcome. This was a retrospective study of 33 adults with intractable mTLE who underwent left temporal lobe surgery at three different epilepsy surgery centers who also underwent pre-, and at least 6-month post-surgical neuropsychological testing. Measures included the Boston Naming Test (BNT) and the Engel Epilepsy Surgery Outcome Scale. Fisher\'s exact tests revealed a statistically significant decline in naming in ATLs compared to SLAHs, but no other significant group differences. 82% of ATL and 36% of subSAH patients showed a significant naming decline whereas no SLAH patient (0%) had a significant naming decline. Significant postoperative naming improvement was seen in 36% of SLAH patients in contrast to 9% improvement in subSAH patients and 0% improvement in ATLs. Finally, there were no statistically significant differences between surgical approaches with regard to seizure freedom outcome, although there was a trend towards better seizure relief outcome among the ATL patients. Results support a possible benefit of SLAH in preserving visual confrontation naming after left TLE surgery. While result interpretation is limited by the small sample size, findings suggest outcome is likely to differ by surgical approach, and that further research on cognitive and seizure freedom outcomes is needed to inform patients and providers of potential risks and benefits with each.
摘要：
这项研究的目的是系统地检查三种不同的手术方法来治疗左内侧颞叶癫痫（mTLE）（即,颞下选择性杏仁核海马切除术[subSAH]，立体定向激光杏仁核海马切除术[SLAH]，和颞叶前切除术[ATL])，确定哪些程序在视觉对抗命名和癫痫缓解结果方面最有利。这是一项回顾性研究，对33名患有难治性mTLE的成年人进行了回顾性研究，他们在三个不同的癫痫手术中心接受了左颞叶手术，和至少6个月的手术后的神经心理测试。措施包括波士顿命名测试（BNT）和恩格尔癫痫手术结果量表。Fisher的精确检验表明，与SLAH相比，ATL的命名在统计上显着下降，但没有其他显著的组间差异。82％的ATL和36％的subSAH患者显示出明显的命名下降，而没有SLAH患者（0％）出现明显的命名下降。36％的SLAH患者术后命名显着改善，而SAH下患者改善9％，ATL改善0％。最后,关于癫痫发作自由结局，手术入路之间没有统计学上的显著差异，尽管ATL患者有更好的癫痫缓解结局的趋势.结果支持SLAH在保留左TLE手术后的视觉对抗命名方面的可能益处。虽然结果解释受到样本量小的限制，研究结果表明，手术方法的结果可能有所不同，并且需要对认知和癫痫发作自由结局进行进一步研究，以告知患者和提供者每种疾病的潜在风险和益处。
