OBJECTIVE We compared long-term seizure outcome, neuropsychological outcome, and occupational outcome of anterior temporal lobectomy (ATL) with and without sparing of mesial structures to determine whether mesial sparing temporal lobectomy prevents memory decline and thus disability, with acceptable seizure outcome. METHODS We studied patients (n = 21) and controls (n = 21) with no evidence of mesial temporal sclerosis (MTS) on MRI who had surgery to treat drug-resistant epilepsy. Demographic and pre- and postsurgical clinical characteristics were compared. Patients had neuropsychological assessment before and after surgery. Neuropsychological analyses were limited to patients with left-sided surgery and available data (n = 14 in each group) as they were at risk of verbal memory impairment. The California Verbal Learning Test II (CVLT-II) (sum of trials 1-5, delayed free recall) and the Logical Memory subtest of the Wechsler Memory Scale III or IV (WMS-III or WMS-IV) (learning and delayed recall of prose passages) were used to assess verbal episodic learning and memory. Seizure and occupational outcomes were assessed. RESULTS The chance of attaining seizure freedom was similar in the two groups, so sparing mesial temporal structures did not lessen the chance of stopping seizures. Sparing mesial temporal structures mitigated the extent of postoperative verbal memory impairment, though some of these individuals suffered decline as a consequence of surgery. Occupational outcome was similar in both groups. SIGNIFICANCE Mesial temporal sparing resections provide a similar seizure outcome as ATL, while producing a better memory outcome. Anterior temporal lobectomy including mesial structure resection did not increase the risk of postoperative disability.

中文翻译：

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内侧颞叶保留颞叶手术治疗难治性癫痫的结果

目的 我们比较了保留和不保留内侧结构的前颞叶切除术 (ATL) 的长期癫痫发作结果、神经心理学结果和职业结果，以确定内侧保留颞叶切除术是否可以预防记忆力下降，从而预防残疾，癫痫发作结果可以接受。方法 我们研究了患者 (n = 21) 和对照组 (n = 21)，这些患者在 MRI 上没有证据表明内侧颞叶硬化 (MTS) 接受了治疗耐药性癫痫的手术。比较了人口统计学和手术前后的临床特征。患者在手术前后进行神经心理评估。神经心理学分析仅限于左侧手术患者和可用数据（每组 n = 14），因为他们有语言记忆障碍的风险。加州语言学习测试 II (CVLT-II)（试验 1-5 的总和，延迟自由回忆）和韦氏记忆量表 III 或 IV（WMS-III 或 WMS-IV）的逻辑记忆子测试（学习和延迟回忆散文段落）被用来评估口头情景学习和记忆。癫痫发作和职业结果进行了评估。结果 两组获得无癫痫发作的机会相似，因此保留内侧颞叶结构并没有减少停止癫痫发作的机会。保留内侧颞叶结构减轻了术后言语记忆障碍的程度，尽管其中一些人因手术而出现衰退。两组的职业结果相似。意义 内侧颞叶保留切除术提供与 ATL 相似的癫痫发作结果，同时产生更好的记忆结果。