Epilepsy is the most common form of chronic neurologic disease. Here, we review the available randomized controlled trials (RCTs) that examined the efficacy of resective epilepsy surgery in select patients suffering from medically intractable epilepsy (defined as persistent epilepsy despite two or more antiepileptic drugs [AEDs]). Three RCTs (two adult RCTs and one pediatric RCT) consistently supported the efficacy of resective surgery as treatment for epilepsy with semiology localized to the mesial temporal lobe. In these studies, 58–100% of the patients who underwent resective surgery achieved seizure freedom, in comparison to 0–13% of medically treated patients. In another RCT, the likelihood of seizure freedom after resective surgery was independent of the surgical approach (transSylvian [64%] versus subtemporal [62%]). Two other RCTs demonstrated that hippocampal resection is essential to optimize seizure control. But, no significant gain in seizure control was achieved beyond removing 2.5 cm of the hippocampus. Across RCTs, minor complications (deficit lasting < 3 months) and major complications (deficit > 3 months) ranged 2–5% and 5–11% respectively. However, nonincapacitating superior subquadrantic visual-field defects (not typically considered a minor or major complication) were noted in up to 55% of the surgical cohort. The available RCTs provide compelling support for resective surgery as a treatment for mesial temporal lobe epilepsy and offer insights toward optimal surgical strategy.

癫痫是最常见的慢性神经系统疾病。在这里，我们回顾了现有的随机对照试验 (RCT)，这些试验检查了切除性癫痫手术对患有医学难治性癫痫（定义为尽管使用两种或多种抗癫痫药物 [AED] 的持续性癫痫）患者的疗效。三项 RCT（两项成人 RCT 和一项儿科 RCT）一致支持切除手术治疗癫痫的疗效，其符号学定位于颞叶内侧。在这些研究中，接受切除手术的患者中有 58-100% 实现了无癫痫发作，而接受药物治疗的患者则为 0-13%。在另一项 RCT 中，切除手术后无癫痫发作的可能性与手术方法无关（跨侧裂 [64%] 与颞下 [62%]）。另外两项 RCT 表明，海马切除术对于优化癫痫发作控制至关重要。但是，除了去除 2.5 厘米的海马体外，癫痫发作控制没有显着提高。在 RCT 中，轻微并发症（缺陷持续 < 3 个月）和主要并发症（缺陷 > 3 个月）的范围分别为 2-5% 和 5-11%。然而，在多达 55% 的手术队列中注意到非失能的上象限下视野缺损（通常不被视为轻微或严重并发症）。现有的 RCT 为切除性手术作为颞叶内侧癫痫的治疗提供了强有力的支持，并为最佳手术策略提供了见解。5 厘米的海马体。在 RCT 中，轻微并发症（缺陷持续 < 3 个月）和主要并发症（缺陷 > 3 个月）的范围分别为 2-5% 和 5-11%。然而，在多达 55% 的手术队列中注意到非失能的上象限下视野缺损（通常不被视为轻微或严重并发症）。现有的 RCT 为切除性手术作为颞叶内侧癫痫的治疗提供了强有力的支持，并为最佳手术策略提供了见解。5 厘米的海马体。在 RCT 中，轻微并发症（缺陷持续 < 3 个月）和主要并发症（缺陷 > 3 个月）的范围分别为 2-5% 和 5-11%。然而，在多达 55% 的手术队列中注意到非失能的上象限下视野缺损（通常不被视为轻微或严重并发症）。现有的 RCT 为切除性手术作为颞叶内侧癫痫的治疗提供了强有力的支持，并为最佳手术策略提供了见解。