ObjectivesAmygdala enlargement is detected on magnetic resonance imaging (MRI) in some patients with drug‐resistant temporal lobe epilepsy (TLE), but its clinical significance remains uncertain We aimed to assess if the presence of amygdala enlargement (1) predicted seizure outcome following anterior temporal lobectomy with amygdalohippocampectomy (ATL‐AH) and (2) was associated with specific histopathological changes.MethodsThis was a case–control study. We included patients with drug‐resistant TLE who underwent ATL‐AH with and without amygdala enlargement detected on pre‐operative MRI. Amygdala volumetry was done using FreeSurfer for patients who had high‐resolution T1‐weighted images. Mann–Whitney U test was used to compare pre‐operative clinical characteristics between the two groups. The amygdala volume on the epileptogenic side was compared to the amygdala volume on the contralateral side among cases and controls. Then, we used a two‐sample, independent t test to compare the means of amygdala volume differences between cases and controls. The chi‐square test was used to assess the correlation of amygdala enlargement with (1) post‐surgical seizure outcomes and (2) histopathological changes.ResultsNineteen patients with and 19 patients without amygdala enlargement were studied. Their median age at surgery was 38 years for cases and 39 years for controls, and 52.6% were male. There were no statistically significant differences between the two groups in their pre‐operative clinical characteristics. There were significant differences in the means of volume difference between cases and controls (Diff = 457.2 mm3, 95% confidence interval [CI] 289.6–624.8; p < .001) and in the means of percentage difference (p < .001). However, there was no significant association between amygdala enlargement and surgical outcome (p = .72) or histopathological changes (p = .63).SignificanceThe presence of amygdala enlargement on the pre‐operative brain MRI in patients with TLE does not affect the surgical outcome following ATL‐AH, and it does not necessarily suggest abnormal histopathology. These findings suggest that amygdala enlargement might reflect a secondary reactive process to seizures in the epileptogenic temporal lobe.

中文翻译：

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颞叶癫痫的杏仁核增大：组织病理学和手术结果

目的 磁共振成像 (MRI) 在一些耐药颞叶癫痫 (TLE) 患者中检测到杏仁核增大，但其临床意义仍不确定 我们的目的是评估杏仁核增大 (1) 的存在是否可预测前颞叶癫痫发作后的结果肺叶切除术联合杏仁核海马切除术 (ATL-AH) 和 (2) 与特定的组织病理学变化相关。方法这是一项病例对照研究。我们纳入了接受 ATL-AH 治疗的耐药 TLE 患者，术前 MRI 检测到有或没有杏仁核增大。使用 FreeSurfer 对拥有高分辨率 T1 加权图像的患者进行杏仁核体积测定。曼-惠特尼U采用检验方法比较两组患者术前的临床特征。将病例和对照中致癫痫侧的杏仁核体积与对侧的杏仁核体积进行比较。然后，我们使用了双样本、独立的t测试比较病例和对照之间杏仁核体积差异的平均值。卡方检验用于评估杏仁核增大与（1）术后癫痫发作结果和（2）组织病理学变化的相关性。结果研究了 19 名患有杏仁核增大的患者和 19 名没有杏仁核增大的患者。接受手术的病例中位年龄为 38 岁，对照组为 39 岁，其中 52.6% 为男性。两组术前临床特征无统计学差异。病例和对照之间的体积差异均值存在显着差异（Diff = 457.2 mm）3，95% 置信区间 [CI] 289.6–624.8；p< .001) 和百分比差异的平均值 (p< .001)。然而，杏仁核增大与手术结果之间没有显着相关性（p= .72) 或组织病理学变化 (p= .63). 意义 TLE 患者术前脑 MRI 上出现杏仁核增大并不影响 ATL-AH 后的手术结果，也不一定表明组织病理学异常。这些发现表明杏仁核增大可能反映了致癫痫颞叶癫痫发作的继发反应过程。