目的:尽管颞叶前叶切除加杏仁核海马切除术(ATL+AH)对颞叶癫痫(TLE)患者有益处,大约高达5%的患者可能有偏瘫作为其术后并发症。本文旨在描述具有AH的ATL的哪个步骤/s具有最大的MEP振幅减小的最大概率。
方法:本研究采用横断面设计,从接受ATL+AH和TcMEP监测的TLE患者中获取数据。评估以下每个步骤的MEP振幅的降低:1)硬脑膜开口,2)打开下喇叭,2)垂直颞叶切除3)下静脉夹层,4)颞叶茎切除术,5)颞叶外侧切除术,6)海马切除术,7)杏仁核切除术,8)子宫切除和9)硬膜闭合。
结果:本研究纳入了19例患者。根据弗里德曼测试,一个或多个步骤的平均MEP幅度降低显著不同(Friedman=50.7,p=0.0001).与基线(100%,截止p=0.005),海马切除(z=-3.81,p<0.0001),T1下解剖(z=-3.2,p=0.0010),肠切除(z=-3.48,p=0.0002),颞叶茎切除(z=-3.26,p=0.001),颞叶外侧切除术(z=-3.13,p=0.002)和杏仁核切除术(-z=-3.37,p=0.0005)明显较低。其中,海马切除术,肠切除和杏仁核切除术被认为是非常重要的。
结论:在杏仁核期间,MEP振幅趋于降低,由于手术操作脉络膜动脉可能导致偏瘫,因此在这些步骤中应仔细注意MEP的变化。
OBJECTIVE: Despite the benefits of anterior temporal lobectomy with amygdalohippocampectomy in patients with temporal lobe epilepsy (TLE), approximately up to 5% may have hemiparesis as its postoperative complication. This paper aims to describe which step/s of the anterior temporal lobectomy with amygdalohippocampectomy have the highest probability of having the greatest decrease in motor evoked potential (MEP) amplitude.
METHODS: This
study used a cross-sectional design of obtaining data from TLE patients who underwent anterior temporal lobectomy with amygdalohippocampectomy with transcranial MEP monitoring. Each of the following steps were evaluated for reduction in MEP amplitude: 1) dural opening, 2) opening the inferior horn, 2) vertical temporal lobe resection 3) subpial dissection, 4) temporal lobe stem resection, 5) lateral temporal lobe resection, 6) hippocampal resection, 7) amygdala resection, 8) uncus resection, and 9) dural closure.
RESULTS: Nineteen patients were included in the
study. Based on the Friedman Test, 1 or more steps had significantly different average MEP amplitude reductions (Friedman = 50.7, P = 0.0001). When compared with baseline (100%, cutoff P = 0.005), hippocampal resection (z = -3.81, P < 0.0001), T1 subpial dissection (z = -3.2, P = 0.0010), uncus resection (z = -3.48, P = 0.0002), temporal stem resection (z = -3.26, P = 0.001), lateral temporal lobe resection (z = -3.13, P = 0.002), and amygdalectomy (-z = -3.37, P = 0.0005) were significantly lower. Of these, hippocampal resection, uncus resection, and amygdalectomy were deemed highly significant.
CONCLUSIONS: MEP amplitude tends to decrease during amygdala, hippocampal, and uncal resection because of surgical manipulation of anterior choroidal arteries, which can potentially cause hemiparesis. Careful attention should be paid to changes in MEP during these steps.