Journal of Korean Neurosurgical Society
- 제29권12호
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- Pages.1650-1656
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- 2000
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- 2005-3711(pISSN)
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- 1598-7876(eISSN)
전측두엽 절제술시 해마체 절제 범위와 경련 예후
The Seizure Outcome and Extent of Hippocampal Resection in Anterior Temporal Lobectomy
- 이완수 (울산대학교 의과대학 신경외과학교실) ;
- 이정교 (울산대학교 의과대학 신경외과학교실) ;
- 이상암 (울산대학교 의과대학 신경과학교실) ;
- 강중구 (울산대학교 의과대학 신경과학교실) ;
- 고태성 (울산대학교 의과대학 소아과학교실)
- Lee, Wan Su (Department of Neurosurgery, College of Medicine, Ulsan University) ;
- Lee, Jung Kyo (Department of Neurosurgery, College of Medicine, Ulsan University) ;
- Lee, Sang Am (Department of Neurology, College of Medicine, Ulsan University) ;
- Kang, Jung Ku (Department of Neurology, College of Medicine, Ulsan University) ;
- Ko, Tae Seong (Department of Pediatrics, College of Medicine, Ulsan University)
- 투고 : 2000.08.02
- 심사 : 2000.08.31
- 발행 : 2000.12.28
초록
Objective : Little consensus exists concerning which temporal lobe structures need to be resected or how much resection should be done during hippocampal resection. The purpose of this study is to identify whether the extent of hippocampal resection influences seizure after anterior temporal lobectomy. Materials and Methods : The extent of hippocampal resection was assessed in 96 patients who underwent temporal lobectomy for medically intractable complex partial seizures originating from a unilateral seizure focus in the anteromesial temporal lobe. Patients who had structural lesion were excluded from the study. Postoperative magnetic resonance imaging in the coronal and saggital planes were used to quantify the extent of the hippocampal and lateral cortical resection. The patients were divided into two groups. Patients who underwent hippocampal resection to the level of the cerebral peduncle were included in the partial resection group, and those who had resection to the level of the colliculus were assigned to total resection group. Seizure outcomes were defined according to the Engel classification and compared between the two groups. Neuropsychologic outcomes in the selected cases were reviewed. Results : The over-all seizure-free outcome(Engel classification 1) was accomplished in 75%(72/96) of the patients (mean duration of follow-up, 36.8 months). The total hippocampectomy group had a statistically superior seizure outcome than the partial hippocampectomy group(87.3% versus 58.5% seizure-free, p-value=0.001). Also, younger patients had a more favorable outcome. Other variables such as laterality, the extent of lateral cortical resection, age at onset and gender were not significant. The pre- and postoperative memory functions were evaluated in 24 patients. A worse postoperative memory outcome was associated with partial hippocampectomy. However this was not acceptable due to a former bias. Conclusion : The result of this study conforms that aggressive hippocampectomy resulted in a better seizure outcome.