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1.
1999年间,我科采用MRI定位行立体定向杏仁核海马毁损术治疗颞叶癫痫33例,经1年的随访,优秀率达57.6%。报道如下:1对象与方法1.1一般资料33例中,男性27例,女性6例;年龄4~44岁。患病时间1~24年。1.2主要临床表现大发作30例,其中精神运动性发作13例;小发作3例。1.3MRI检查MRI检查均无占位病变或其他可引起继发性癫痫的病灶。海马硬化10例。1.4EEG检查所有病人均经反复多次EEG检查(5次以上),痫灶定位于一侧颞叶。1.5治疗方法病人安装Leksell立体定向头架后,行头颅MRI,… 相似文献
2.
目的 探讨立体定向杏仁核海马毁损术治疗颞叶内侧型癫痫的有效性,同时评价深部电极记录的发作间歇期痫性放电定位致痫灶的准确性. 方法 选择南方医院神经外科门诊自1998年7月至2003年10月收治的21例顽固性颞叶癫痫患者,行立体定向杏仁核海马毁损术.术中在毁损靶点前后行深部电极记录,统计发作间歇期痫性放电发生频率. 结果 术后随访21例,其中EngelⅠ级6例,Ⅱ级2例,Ⅲ级5例,Ⅳ级3例,Ⅴ级5例.有效者(Ⅰ+Ⅱ+Ⅲ级)13例,无效者(Ⅳ+Ⅴ级)8例,有效率为62%.深部电极记录的发作间歇期痫性放电手术前后的发生频率差异无统计学意义(P>0.05). 结论 立体定向射频毁损杏仁核海马手术治疗颞叶内侧型癫痫安全有效.深部电极记录的发作间歇期痫性放电定侧价值较高,而定位价值低. 相似文献
3.
目的分析采用杏仁核海马立体定向射频热凝毁损术(SAHE)治疗内侧颞叶癫痫的方法、癫痫控制情况及神经心理学功能影响,评估SAHE的效果及安全性。方法选取48例内侧颞叶癫痫行外科手术治疗患者为研究对象,分析其一般资料、SAHE治疗方法及术后癫痫发作消失率、神经心理学功能术后检测情况。结果手术均顺利完成,术后随访6个月~2年,癫痫完全控制率为52.1%,治疗显效率为75.0%,总有效率为89.6%,术后11例(22.9%)患者出现轻度头痛,9例(18.8%)患者术后出现低热,均为给予特殊治疗,未影响后续治疗,后1周患者PIQ、VIQ、MQ有所下降,但是在之后的随访中发现患者术后6个月在神经心理功能各维度评测结果均已恢复至术前水平,术后1周患者PIQ、VIQ、MQ有所下降,但是在之后的随访中发现患者术后6个月在神经心理功能各维度评测结果均已恢复至术前水平。结论 SAHE对内侧颞叶癫痫的治疗效果显著,能够有效的减少术后癫痫发作次数,术后早期会对患者的语言、操作智商、记忆力有一定影响,但长远观察可恢复正常,安全性良好,值得临床推广应用。 相似文献
4.
正1病例资料女性,26岁,因反复发作反酸伴意识丧失14年入院。病人12岁起,反复出现发作性反酸,继之愣神、咂嘴、摸索,呼之不应,1~2 min后意识丧失、口吐白沫、四肢抽搐,持续数分钟,单独或联合服用苯妥英钠、卡马西平、丙戊酸钠等药物无效,几乎每天都发作,多时每天6~7次。神经系统检查及头部MRI未见异常,长程视频脑电图监测到癫痫发作,发作期右颞叶首先出现棘-慢波并向双侧扩散,发作间期可见双侧慢 相似文献
5.
目的探讨立体定向杏仁核海马毁损治疗颞叶癫痫的原理、方法和疗效。方法患者头部安装MD~2000立体定向框架。使其平行于颞角长轴。针对12例颞叶顽固性癫痫患者,应用头部MRI扫描定位,局麻下深部电极行杏仁核及海马脑电监测和射频毁损术。结果射频毁损前12例患者深部电极均记录到杏仁核和海马区棘波、尖波或多棘波,术后显示痴样放电消失。术后随访9~18个月.癫痫发作完全控制者58.3%(7/12),显著改善33.3%(4/12)。结论立体定向杏仁核海马毁损术治疗颞叶顽固性癫痫是一种安全有效的微创治疗方法,值得临床推广。 相似文献
6.
目的探讨立体定向手术热凝毁损海马杏仁核治疗海马病变所致难治性颞叶内侧癫癎的疗效。方法回顾分析19例由海马病变所致难治性颞叶内侧癫癎患者的临床表现、影像学(CT/MRI)脑电图(EEG/VEEG)资料和手术疗效。所有病例术前均行动态脑电图检查明确致癎灶完成定位诊断、术中行立体定向组织活检、快速冰冻病理确诊病变性质完成定性诊断。全部患者在计算机辅助下行致癎灶侧海马杏仁核立体定向热凝毁损术。手术效果按谭启富的评定标准进行评价。结果随访12~42个月,13例癫癎未再发作(满意),4例发作次数减少75%以上(明显改善),2例发作次数减少50%(改善)。未发现神经心理学改变及神经功能障碍等并发症。结论对于由海马病变所致难治性颞叶内侧癫癎,采用立体定向手术行海马杏仁核热凝毁损是控制癫癎发作的一种安全有效方法。 相似文献
8.
目的探讨立体定向手术热凝毁损海马杏仁核治疗海马病变所致难治性颞叶内侧癫癎的疗效。方法回顾分析19例由海马病变所致难治性颞叶内侧癫癎患者的临床表现、影像学(CT/MRI)脑电图(EEG/VEEG)资料和手术疗效。所有病例术前均行动态脑电图检查明确致癎灶完成定位诊断、术中行立体定向组织活检、快速冰冻病理确诊病变性质完成定性诊断。全部患者在计算机辅助下行致癎灶侧海马杏仁核立体定向热凝毁损术。手术效果按谭启富的评定标准进行评价。结果随访12~42个月,13例癫癎未再发作(满意),4例发作次数减少75%以上(明显改善),2例发作次数减少50%(改善)。未发现神经心理学改变及神经功能障碍等并发症。结论对于由海马病变所致难治性颞叶内侧癫癎,采用立体定向手术行海马杏仁核热凝毁损是控制癫癎发作的一种安全有效方法。 相似文献
9.
目的 探讨选择性杏仁核-海马切除术(SAH)对内侧颞叶癫痫病人认知功能的影响。方法 回顾性分析2009年1月~2017年5月接受SAH治疗的67例内侧颞叶癫痫的临床资料,术前、术后3个月和术后1年均行详细的神经心理学评估,包括智商、记忆商和语言功能。结果 36例行左侧SAH,31例行右侧SAH。术后1年,癫痫控制效果达到Engel分级Ⅰ级50例,Ⅱ级7例,Ⅲ级8例,Ⅳ级2例。术后3个月,左侧手术病人言语功能、记忆商较术前明显降低(P<0.05),右侧手术病人言语理解指数、语义流畅性测验明显改善(P<0.05);术后1年,无论是左侧手术病人,还是右侧手术病人,智商、记忆商、言语功能较术后3个月略改善(P>0.05);手术前后视觉记忆均无明显变化(P>0.05)。结论 海马硬化性内侧颞叶癫痫行SAH后,左侧手术病人会出现比较明显的言语和记忆功能减低。 相似文献
11.
To search for a method for treatment of bilateral temporal lobe epilepsy (BTLE), we report one patient with BTLE experienced bilateral stereotactic radiofrequency amygdalohippocampectomy (SAHE). Neuropsychological examinations were performed before and 5 days, and 6, 18, and 48 months after operation. No seizure occurred in the follow‐up time, and no long‐term memory and intelligence deficits were found except for a transient decline of the scores immediately after operation. Because severe damage of memory could be caused by bilateral resection surgery, bilateral SAHE should be considered as a possible approach for the treatment of BTLE. However, further studies with accumulation of cases are needed, especially in the detailed assessment of neuropsychological function. 相似文献
12.
目的 采用选择性海马-杏仁核切除术治疗内侧颞叶癫痫85例,探讨手术入路的选择及治疗效果。方法 总结2000年~2004年85例选择性海马-杏仁核切除手术病例的术前临床表现、影像检查、视频脑电图和脑磁图所见以及外科手术方法,观察随访结果。结果 术后74.2%癫痫发作停止。Engel癫痫疗效分级:1级74.2%,2级16.5%,3级5.1%,4级4.2%。总有效率为95.8%。结论 选择性海马-杏仁核切除术对80%以上的内侧颞叶癫痫有效。颧弓翼点经颞下沟入路安全有效。颞底海马旁回入路可避免损伤颞叶新皮质。 相似文献
13.
目的 探讨经颞下回-侧脑室入路选择性海马杏仁核切除术治疗内侧颞叶癫痫的手术方法 、疗效及并发症. 方法 对确诊为药物难治性内侧颞叶癫痫的62例患者,经颞部锁孔开颅,切除中前段颞下回,进入颞角前外侧区,选择性切除海马杏仁核及海马旁回等内侧颞叶结构.结果 62例患者术后随访至少24~80个月,无严重手术并发症;Engel癫痫疗效分级;Ⅰ级45例(72.6%),Ⅱ级12例(19.4%),Ⅲ级5例(8.0%). 结论 经颢下回-侧脑室入路选择性海马杏仁核切除术是治疗内侧颞叶癫痫的有效方法 ,其手术创伤小,可妥善保护语言区和视放射,安全性高. 相似文献
14.
Objective: Selective amygdalohippocampectomy (SAH) can be used to obtain satisfactory seizure control in patients with mesial temporal lobe epilepsy (MTLE). Several SAH procedures have been reported to achieve satisfactory outcomes for seizure control, but none yield fully satisfactory outcomes for memory function. We hypothesized that preserving the temporal stem might play an important role. To preserve the temporal stem, we developed a minimally invasive surgical procedure, ‘neuronavigation-assisted trans-inferotemporal cortex SAH’ (TITC-SAH). Methods: TITC-SAH was performed in 23 patients with MTLE (MTLE on the language-non-dominant hemisphere, n = 11). The inferior horn of the lateral ventricle was approached via the inferior or middle temporal gyrus along the inferior temporal sulcus under neuronavigation guidance. The hippocampus was dissected in a subpial manner and resected en bloc together with the parahippocampal gyrus. Seizure control at one year and memory function at 6 months postoperatively were evaluated. Results: One year after TITC-SAH, 20 of the 23 patients were seizure-free (ILAE class 1), 2 were class 2, and 1 was class 3. Verbal memory improved significantly in 13 patients with a diagnosis of hippocampal sclerosis, for whom WMS-R scores were available both pre- and post-operatively. Improvements were seen regardless of whether the SAH was on the language-dominant or non-dominant hemisphere. No major complication was observed. Conclusion: Navigation-assisted TITC-SAH performed for MTLE offers a simple, minimally invasive procedure that appears to yield excellent outcomes in terms of seizure control and preservation of memory function, because this procedure does not damage the temporal stem. TITC-SAH should be one of the feasible surgical procedures for MTLE. Abbreviations: SAH: Amygdalohippocampectomy; MTLE: Mesial temporal lobe epilepsy (MTLE); TITC-SAH: Ttrans-inferotemporal cortex SAH; ILAE: International League Against Epilepsy (ILAE); MRI: Magnetic resonance imaging; EEG: Electroencephalography (EEG); FDG-PET: 8F-fluorodeoxyglucose (FDG)-positron emission tomography; ECoG: Electrocorticography; MEG: Magnetoencephalography; IMZ-SPECT: N-isopropyl-p(123I)-iodoamphetamine single photon emission computed tomography; WMS-R: Wechsler Memory Scale-Revised. 相似文献
16.
Introduction
Familial
mesial temporal lobe epilepsy (FMTLE)
is characterized by prominent
psychic and autonomic seizures, often
without hippocampal sclerosis
(HS) or a previous history of
febrile seizures (FS), and good
prognosis. The genetics of this condition
is largely unknown.We present
the electroclinical and genetic
findings of 15 MTLE Italian families.
Patients and methods
FMTLE
was defined when two or more
first-degree relatives had epilepsy
suggesting a mesial temporal lobe
origin. The occurrence of seizures
with auditory auras was considered
an exclusion criterion. Patients underwent
video-EEG recordings, 1.5-Tesla MRI particularly focused on
hippocampal analysis, and neuropsychological
evaluation. Genetic
study included genotyping and
linkage analysis of candidate loci at
4q, 18q, 1q, and 12q as well as
screening for LGI1/Epitempin mutations.
Results
Most of the families
showed an autosomal dominant inheritance
pattern with incomplete
penetrance. Fifty-four (32 F) affected
individuals were investigated.
Twenty-one (38.8 %) individuals
experienced early FS.
Forty-eight individuals fulfilled the
criteria for MTLE. Epigastric/visceral
sensation (72.9 %) was the
most common type of aura, followed
by psychic symptoms
(35.4 %), and déjà vu (31.2 %). HS
occurred in 13.8% of individuals,
three of whom belonged to the
same family. Prognosis of epilepsy
was generally good. Genetic study
failed to show LGI1/Epitempin mutations
or significative linkage to
the investigated loci.
Discussion
FMTLE may be a more common
than expected condition, clinically
and genetically heterogeneous.
Some of the reported families,
grouped on the basis of a specific
aura, may represent an interesting
subgroup on whom to focus future
linkage studies. 相似文献
17.
目的观察前颞叶切除术和选择性海马、杏仁核切除术对颞叶内侧癫痫的发作控制效果是否有差别。方法 2009年1月至2010年12月在我科行前颞叶切除术的67例颞叶内侧患者为A组;2011年6月至2013年5月在我科行选择性海马、杏仁核切除术的46例颞叶内侧患者为B组;统计分析两组术后1年发作控制为Engel I-II级和Engel III-IV级的人数。结果 A组Engel I-II级56例(83.58%),Engel III-IV级11例(16.42%);B组Engel I-II级40例(86.95%),Engel III-IV级6例(13.05%)。经χ2检验两组术后对MTLE发作的控制率无统计学差异,χ2=0.243,P0.05。结论前颞叶切除术和选择性海马、杏仁核切除术对颞叶内侧癫痫发作都能获得良好的控制,两者疗效无明显差异。 相似文献
18.
PURPOSE: In the surgical treatment of mesial temporal lobe epilepsy, there is converging evidence that individually tailored or selective approaches have a favorable cognitive outcome compared to standard resections. There is, however, also evidence that due to collateral damage, selective surgery can be less selective than suggested. As part of a prospective transregional research project the present study evaluated the outcome in memory and nonmemory functions, following two selective approaches: a combined temporal pole resection with amygdalohippocampectomy (TPR+) and transsylvian selective amygdalohippocampectomy (SAH). METHODS: One year after surgery, cognitive outcomes of postoperatively seizure-free patients with mesial TLE and hippocampal sclerosis, who underwent either TPR+ (N = 35) or SAH (N = 62) in two German epilepsy centers (Bonn/Berlin), were compared. RESULTS: Repeated measurement MANOVA and separate post hoc testing indicated a double dissociation of verbal/figural memory outcome as dependent on side and type of surgery. Verbal memory outcome was worse after left-sided operation, but especially for SAH, whereas figural memory outcome was worse after right-sided operation, preferentially for TPR+. Attention improved independent of side or type of surgery, and language functions showed some improvement after right-sided surgeries. DISCUSSION: The results indicate a differential effect of left/right SAH versus TPR+ on material-specific memory insofar as transsylvian SAH appears to be favorable in right and TPR+ in left MTLE. The different outcomes are discussed in terms of a different surgical affection of the temporal pole and stem, and different roles of these structures for verbal and figural memory. 相似文献
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