■内侧颞叶癫痫(MTLE)是外科系列中最常见的局灶性癫痫之一,尤其是成年人。几十年来,已经开发了不同的手术策略来解决耐药性癫痫,同时保护神经和认知功能.在这些战略中,前颞叶切除术(ATL),涉及移除颞极和内侧颞叶结构,已经成为一种广泛使用的技术。已经提出了许多修改来减轻与失语症相关的风险,认知问题,和视野缺陷。
■我们的方法通过术中和尸体解剖得以阐明,辅以关键解剖标志的神经放射学和尸体测量。对使用我们的ATL技术在IRCCSNeuromed(Pozzilli)治疗的耐药MTLE患者进行了回顾性分析。
■总共385名患者接受了我们的ATL下技术的治疗,解剖学上集中在前Sylvian点(ASyP)。平均FU为9.9±5.4年(范围1-24)。总的来说,84%的患者在最后一次随访中没有癫痫发作,没有永久性的神经缺陷.暂时性缺陷如下:3%的患者失语症,2%的患者视野缺损,2%的患者偏瘫,0.8%的患者有认知/记忆障碍。在尸体解剖中,在右侧与颞极的平均距离为3.4±0.2cm(范围3-3.8),在左侧与3.5±0.2cm(3.2-3.9)。在神经成像中,在所有情况下,在右侧平均距离为3.2±0.3mm(范围2.7-3.6)和左侧平均距离为3.5±0.4mm(范围2.8-3.8)的情况下,在颞角尖端均出现了ASyP。
■据我们所知,这项研究首先介绍了作为一个可靠的和可重复的皮质标志进行ATL,以克服病人的变异性,迈耶环受伤的风险,以及术中测量的偏差。我们的发现表明,ASyP可以是一个安全的皮质标志,在MTLE手术中很有用,因为它一直存在并且在颞角和语言网络等危险的颞区之前。
UNASSIGNED: Mesial temporal lobe epilepsy (MTLE) is one of the most prevalent forms of focal epilepsy in surgical series, particularly among adults. Over the decades, different surgical strategies have been developed to address drug-resistant epilepsy while safeguarding neurological and cognitive functions. Among these strategies, anterior temporal lobectomy (ATL), involving the removal of the temporal pole and mesial temporal structures, has emerged as a widely employed technique. Numerous modifications have been proposed to mitigate the risks associated with aphasia, cognitive issues, and visual field defects.
UNASSIGNED: Our approach is elucidated through intraoperative and cadaveric dissections, complemented by neuroradiological and cadaveric measurements of key anatomical landmarks. A retrospective analysis of patients with drug-resistant MTLE who were treated using our ATL technique at IRCCS Neuromed (Pozzilli) is presented.
UNASSIGNED: A total of 385 patients were treated with our ATL subpial technique anatomically focused on the anterior Sylvian point (ASyP). The mean FU was 9.9 ± 5.4 years (range 1-24). In total, 84%of patients were free of seizures during the last follow-up, with no permanent neurological deficits. Transient defects were as follows: aphasia in 3% of patients, visual field defects in 2% of patients, hemiparesis in 2% of patients, and cognitive/memory impairments in 0.8% of patients. In cadaveric dissections, the ASyP was found at a mean distance from the temporal pole of 3.4 ± 0.2 cm (range 3-3.8) at the right side and 3.5 ± 0.2 cm (3.2-3.9) at the left side. In neuroimaging, the ASyP resulted anterior to the temporal horn tip in all cases at a mean distance of 3.2 ± 0.3 mm (range 2.7-3.6) at the right side and 3.5 ± 0.4 mm (range 2.8-3.8) at the left side.
UNASSIGNED: To the best of our knowledge, this study first introduces the ASyP as a reliable and reproducible cortical landmark to perform the ATL to overcome the patients\' variabilities, the risk of Meyer\'s loop injury, and the bias of intraoperative measurements. Our findings demonstrate that ASyP can be a safe cortical landmark that is useful in MTLE surgery because it is constantly present and is anterior to risky temporal regions such as temporal horn and language networks.