杏仁核体积指数在颞叶内侧癫痫患者手术评估中的作用

The role of amygdala volume index in surgical evaluation in patients with meisal temporal lobe epilepsy

目的探讨颞叶内侧癫痫(mesial temporal lobe epilepsy,mTLE)患侧杏仁核体积指数(Amygdala volume index,AVI)与临床特点、病因的关系,以及AVI对手术疗效的预测作用。方法回顾性分析自2013年3月-2016年3月浙江大学医学院附属第二医院癫痫中心通过临床症状学和视频脑电图(VEEG)诊断的mTLE患者35例。所有患者均接受术前评估,行癫痫专用序列头颅核磁共振(MRI)及VEEG检查。利用3D MRI感兴趣区域(Region of interest,ROI)分析,测量术前MRI双侧杏仁核体积,并计算患侧AVI。35例患者均接受手术治疗,经病理检查明确病因。分析AVI与患者临床特征、病因的相关性以及其对手术疗效的预测作用。结果 35例患者中,患侧AVI与起病年龄(R=-0.389,P=0.019)及手术时的年龄(R=-0.357,P=0.032)均呈负相关,而与性别、热性惊厥史、病程、发作表现、致痫灶定侧、术前发作频率无显著相关(P>0.05)。不同病因的患侧AVI无统计学差异(P>0.05)。术后疗效理想的患者有30例(85.7%),AVI对mTLE患者手术疗效无预测作用(P>0.05)。结论对于mTLE患者,患侧AVI可能对病因有一定提示意义,此外,患侧AVI越大提示起病年龄越早,但在致痫灶定侧及手术疗效预测方面患侧AVI的作用有限。

Objective To investigate the role of amygdala volume index( AVI) in surgcial evaluation in patients with mesial temporal lobe epilepsy( mTLE),including clinical features,etiologies and surgical outcome. Methods Thirty six patients were diagnosed as mTLE after surgical evaluation including clinical manifestations,video-electroencephalogram( VEEG) and magnetic resonance imaging( MRI) at the Second Affiliated Hospital of Zhejiang University between March 2013 and March 2016. Bilateral amygdala AVI was then calculated from amygdala volumes on MRI,which were measured with region of interest( ROI) analysis. All patients were treated surgically. Etiologies of mTLE were further confirmed by the histopathology of the resected tissue. Results Among the 35 patients,there is a strong correlation between AVI on the lesion side and age of onset( R =-0. 389,P = 0. 019) as well as age of surgery( R =-0. 357,P = 0. 032). No obvious relation can be seen between AVI and gender,history of febrile convulsion,duration of epilepsy,secondary generalized seizure, side of lesion, presurgical seizure frequency and electrode implantation. There is no significant difference in AVI among the five etiologies. At follow-up,thirty patients( 80. 5%) reached seizure-free,AVI on the lesion side is nota predictor of surgical failure( P > 0. 05). Conclusion AVI plays a role in etiology evaluation in patients with mesial temporal lobe epilepsy. Moreover,a larger AVI on the lesion side is correlated with an earlier age of onset. There is limited value of amygdala volume insurgical outcome prediction of patients with mTLE.