| Objective:Temporal lobe epilepsy is prone to become drug refractory epilepsy,causing serious effects on the nervous system,in order to find an effective treatment,people have tried a variety of treatment methods including surgical methods.As early as in the 1930s,Penfield et al.pioneered the treatment of medically refractory temporal lobe epilepsy with temporal lobectomy,and achieved certain results.Since then,surgery has become a common treatment for medically refractory temporal lobe epilepsy.With the accumulation of cases and the study of postoperative follow-up,as well as the deepening of the understanding of the structure and function of the temporal lobe,it was found that some cases would have visual field defects,memory loss and other neuropsychological changes after the surgery,which promoted the exploration of new surgical methods and surgical approaches.Since the 1970s,the neuroimaging and electrophysiology and the revolutionary progress of computer technology,makes the potential etiology and pathophysiology of temporal lobe epilepsy have a more in-depth understanding,at the same time with the help of these techniques,can provide more potential resistance in patients with temporal lobe epilepsy is more safe and effective surgical treatment.However,the question of when patients with medically refractory epilepsy should undergo surgery is still controversial,most epileptists,especially epileptic surgeons,believe that for temporal lobe epilepsy,surgical intervention should be carried out as early as possible in cases where two or more medications cannot effectively control the seizure.Currently,the most commonly used surgical methods for temporal lobe epilepsy are standard anterior temporal lobectomy and selective amygdalohippocampectomy.Temporal lobotomy is rarely reported.There are also rare comparative studies on the efficacy of temporal lobe epileptic resection(anterior temporal lobectomy and selective amygdalohippocampectomy)versus temporal lobotomy surgery.In addition,the management of antiepileptic drugs after surgery also varies greatly due to regional differences and the clinical experience of surgeons.Standard and reasonable application of antiepileptic drugs after surgery is also an urgent problem to be solved,and few studies have been conducted on it.This study retrospectively analyzed the postoperative efficacy and postoperative medication of patients with temporal lobe epilepsy treated by single-center surgery in functional neurosurgery department of Huanhu Hospital,in order to provide references for future clinicians in the selection of surgical methods and postoperative drug management for different patients.surgical methods and postoperative drug management for different patients.Methods:A retrospective analysis was conducted on 115 cases of refractory epilepsy surgery in functional neurosurgery department of Tianjin Huanhu hospital from May 2014 to May 2018.There were 64 cases of temporal lobe epilepsy resection,including 58 cases of temporal lobectomy and 6 cases of temporal lobotomy。Among the 58 cases of excision surgery,12 cases with grade 3 or above glioma or other malignant tumors were excluded,or be excluded because of lost follow-up and pathological nature.And 46 cases were included in the study.For medial temporal lobe epilepsy with simple hippocampal sclerosis,17 patients underwent selective amygdalohippocampectomy or anterior temporal lobectomy,and 29 cases underwent anterior temporal lobectomy with hippocampal sclerosis combined with temporal lobe neocortex lesions,or with epilepsy caused by temporal lobe neocortex alone.Finally,a total of 52 cases of temporal lobe epilepsy treated with different open surgery were included in this study.Among them,33 were males and 19 were females,with an average age of 29.9 years(29.9± 13.4)and an average preoperative history of epilepsy of 13.0 years(13.0±9.7).The types of seizure include simple partial seizure,complex partial seizure,partial seizure secondary to systemic seizure,systemic seizure,and premonitory seizure or premonitory secondary comprehensive seizure.Most patients have more than one type of seizure.Before the operation,all the patients took normal antiepileptic drugs,and after more than 2 years of treatment,they still failed to effectively control the seizures.They were diagnosed as medically refractory temporal lobe epilepsy by the epilepsy specialist.For the cases suspected by MRI to be neoplastic lesions,although the course of disease did not reach 2 years,they also chose resection surgery.After a comprehensive multidisciplinary evaluation including clinical symptomatology,imaging,and neuroelectrophysiology,neuropsychology,surgery was performed by the same surgeon.The mean postoperative follow-up time was 3.3years(3.3±1.1).The data of the retrospective analysis included the basic information of 52 patients such as age,gender,medical history and medication,surgical methods,pathological results,postoperative medication and Engel classification of postoperative follow-up results of epilepsy,and they were analyzed and summarized.Adopted Nascimento’s classification methods:Engel Ⅰ-Ⅱ level for postoperative seizures to achieve satisfactory control;EngelⅢ-EngelⅣlevel for postoperative seizures have not reached satisfied control.Results:In 52 patients with temporal lobe epilepsy surgery,at the time of the last follow-up,epilepsy control for Engel Ⅰ level 37 cases(71.2%),Engel Ⅱ level 5 cases(9.6%),Engel Ⅲ level 6 cases(11.5%),Engel Ⅳ level 4 cases(7.7%).There were 11 cases(21.1%)of drug withdrawal after operation.The results of single factor analysis of preoperative course indicated that the preoperative course of disease was less than 20 years in 35 cases(67.3%),32 cases(91.4%)achieved satisfactory control of epilepsy.The duration of the disease was greater than 20 years in 17 cases(32.7%),10 cases(58.8%)achieved satisfactory control of epilepsy.Among the 39 patients(86.7%)who underwent temporal lobectomy,31(79.5%)achieved satisfactory control.Temporal lobotomy was performed in 6 patients(11.5%),6 patients(100.0%)achieved satisfactory control of epilepsy.Among the 38 patients(73.1%)in the monotherapy group,33(86.8%)achieved satisfactory control of postoperative epilepsy.Among the 14 patients(26.9%)in the multi-drug treatment group,9(64.3%)achieved satisfactory control of postoperative epilepsy.Conclusion:Surgery is an effective method for the treatment of intractable temporal lobe epilepsy,and early surgery will be beneficial to the control of postoperative seizures.By comparing the long-term postoperative efficacy of the two methods,it was found that temporal lobotomy could achieve the same rate of postoperative seizure control as resection.However,it is a worthy surgical method to remove less tissue,avoid the complications of excision of more tissue,great damage,and the possibility of postoperative complications such as hematoma or effusion in the operative cavity,thus prolonging the length of stay and the cost.Postoperative single drug treatment or multi-drug treatment has no effect on the long-term efficacy.Considering the economic cost,side effects and psychological acceptance of patients and their families,postoperative single drug treatment is more favorable. |
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