The goal of epilepsy surgery is both seizure cessation and maximal preservation of function. In temporal lobe (TL) cases, the lack of functional MRI (fMRI) tasks that effectively activate mesial temporal structures hampers preoperative memory risk assessment, especially in children. This study evaluated pediatric TL surgery outcome optimization associated with tailored resection informed by an fMRI memory task.

The authors identified focal onset TL epilepsy patients with 1) TL resections; 2) viable fMRI memory scans; and 3) pre- and postoperative neuropsychological (NP) evaluations. They retrospectively evaluated preoperative fMRI memory scans, available Wada tests, pre- and postoperative NP scores, postoperative MRI scans, and postoperative Engel class outcomes. To assess fMRI memory task outcome prediction, the authors 1) overlaid preoperative fMRI activation onto postoperative structural images; 2) classified patients as having "overlap" or "no overlap" of activation and resection cavities; and 3) compared these findings with memory improvement, stability, or decline, based on Reliable Change Index calculations.

Twenty patients met the inclusion criteria. At a median of 2.1 postoperative years, 16 patients had Engel class IA outcomes and 1 each had Engel class IB, ID, IIA, and IID outcomes. Functional MRI activation was linked to NP memory outcome in 19 of 20 cases (95%). Otherwise, heterogeneity characterized the cohort.

Functional MRI memory task activation effectively predicted individual NP outcomes in the context of tailored TL resections. Patients had excellent seizure and overall good NP outcomes. This small study adds to extant literature indicating that pediatric TL epilepsy does not represent a single clinical syndrome. Findings support individualized surgical intervention using fMRI memory activation to help guide this precision medicine approach.

癫痫手术的目标是停止癫痫发作和最大限度地保留功能。在颞叶 (TL) 病例中，缺乏有效激活内侧颞叶结构的功能性 MRI (fMRI) 任务阻碍了术前记忆风险评估，尤其是儿童。这项研究评估了与功能磁共振成像记忆任务通知的定制切除相关的儿科 TL 手术结果优化。

作者通过 1) TL 切除术确定了局灶性 TL 癫痫患者； 2）可行的功能磁共振成像记忆扫描； 3）术前和术后神经心理学（NP）评估。他们回顾性评估了术前 fMRI 记忆扫描、可用的 Wada 测试、术前和术后 NP 评分、术后 MRI 扫描和术后 Engel 分级结果。为了评估 fMRI 记忆任务结果预测，作者 1) 将术前 fMRI 激活叠加到术后结构图像上； 2) 将患者分类为激活腔和切除腔“重叠”或“不重叠”； 3) 根据可靠变化指数计算，将这些发现与记忆力改善、稳定性或下降进行比较。

二十名患者符合纳入标准。术后中位 2.1 年，16 名患者的结果为 Engel IA 级，各 1 名患者的结果为 Engel IB、ID、IIA 和 IID 级。 20 例中有 19 例 (95%) 的功能性 MRI 激活与 NP 记忆结果相关。除此之外，该群体的特征是异质性。

功能性 MRI 记忆任务激活可有效预测在定制 TL 切除情况下的个体 NP 结果。患者有良好的癫痫发作和总体良好的 NP 结局。这项小型研究补充了现有文献，表明小儿 TL 癫痫并不代表单一的临床综合征。研究结果支持使用功能磁共振成像记忆激活进行个体化手术干预，以帮助指导这种精准医疗方法。