术中1.5T核磁共振外科治疗难治性癫癎

目的探讨应用术中1.5T核磁共振(MRI)治疗难治性癫癎的手术效果。方法手术治疗难治性癫癎15例,利用术中1.5T核磁共振,术前常规行T1、T2及T1加强,及弥散张量成像,术中切除(切开)后行T1、T2及T1加强及弥散张量成像检查,以确定切除范围及功能区定位,其中5例术中MR检查后扩大切除。结果左侧枕叶局灶性皮质发育异常2例,左侧颞叶海绵状血管瘤4例,左侧颞叶海马硬化1例,右侧额叶胚胎发育不良性神经上皮肿瘤1例,右侧中央前回局灶性皮质发育不良1例,右侧颞叶海马硬化1例,右侧颞叶海绵状血管瘤1例,右侧颞叶胶质瘤1级1例,右侧中央后回海绵状血管瘤1例,胼胝体切开2例,engle分级:Ⅰ级11例,Ⅱ级4例。结论术中1.5T核磁共振对切除(切开)病灶及功能保护有指导意义。     

MRI海马特殊扫描在颞叶癫痫海马硬化诊断中的应用

目的：确定癫痫病因和定位癫痫病灶对制定手术方案及判断预后至关重要。近年来研究证实70％－90％的慢性癫痫的病人都存在一定程度的结构异常。高清晰度MRI的出现对顽固性癫痫诊断具有划时代的意义。本研究就MRI在评估颞叶癫痫海马硬化中的作用作初步探讨。方法：对顽固性颞叶癫痫26例应用MRI对病人进行海马特殊扫描。结果：在26例顽固性颞叶癫痫病人行海马特殊MRI扫描中，海马和杏仁核区低恶度脑胶质瘤2例，脑囊肿1例，小AVM1例，脑脓肿1例。海马硬化19例（10右侧，7例左侧，2例双侧）。2例未见异常，MRI所示结构异常率为92％（24／26），海马硬化率为73％。前颞叶萎缩18例，侧脑室颞角的不对称性22例，T2加全像高信号表现11例。颞叶癫痫海马硬化MRI主要表现为：1、前颞叶萎缩；2、侧脑室颞角的海马硬化MRI主酹现为：1、前颞叶萎缩；2、侧脑室颞角的不对称性；3、海马萎缩；4、T2加全像高信号表现；5、海马内结构的丢失。结论：应用MRI海马特殊扫描技术诊断颞叶癫痫海马病变其准确率为92％，其对诊断颞叶癫痫海马病变具有较高的实用价值。     

颞叶海绵状血管瘤继发性癫痫手术治疗的效果

目的探讨颞叶海绵状血管瘤继发性癫痫手术治疗的效果。方法回顾性分析我科自2011年3月~2015年6月手术治疗的8例颞叶海绵状血管瘤继发性癫痫患者的临床资料和随访结果。患者术前均行头颅MRI和长程视频脑电图监测等综合评估,术中行皮层脑电监测。结果患者术后随访1~5年;疗效按Engel分级,Ⅰ级5例,Ⅱ级2例,Ⅲ级1例。有4例患者手术2年后逐步停服抗癫痫药物。结论手术治疗颞叶海绵状血管瘤继发性癫痫可取得较好的效果。     

PET-MRI影像融合技术在颞叶癫痫手术中的应用

目的探讨PET-MRI影像融合技术在海马硬化所致颞叶癫痫病人颞前叶切除范围评估中的指导价值。方法 2013年1月至2015年1月前瞻性收集手术治疗海马硬化所致单侧颞叶癫痫10例,根据PET-MRI融合影像显示的低代谢范围决定颞前叶手术切除范围。术后3个月复查PET-CT及MRI,随访1年以上,评估手术短期并发症及癫痫控制情况。结果发作间期PET检查均表现为受累侧颞前叶低代谢,2例合并对侧颞叶代谢减低。术后病理示局灶皮层发育不良Ⅰ型8例,Ⅱ型2例。术后短期没有出现偏瘫、失语、记忆力严重下降。术后平均随访1.9年,EngelⅠa级8例,EngelⅠb级1例,EngelⅠc级1例。结论海马硬化所致颞叶癫痫根据术前PET-MRI融合影像有助于精准定位颞前叶的切除范围,手术对癫痫控制效果良好。     

儿童颞叶癫痫的病因学探讨——附46例病例报道

本文主旨在于总结儿童颞叶癫痫的病因学,并分析其与治疗效果之间的关系。通过回顾性总结在北京天坛医院治疗的46例儿童(小于16岁)颞叶癫痫病例,经综合评估、明确诊断后手术治疗。癫痫控制效果用Engel标准评估。在46例患者中,经MRI扫描、再经病理学确诊的"颞叶肿瘤"21例,"海马硬化"14例,颞叶"皮质发育不良"6例,颞叶"蛛网膜囊肿"5例。21例"颞叶肿瘤"患者中18例行肿瘤和周围皮质(11例患者累及颞叶内侧结构)扩大切除,3例仅切除肿瘤。14例"海马硬化"患者均行Spencer术式切除颞叶前部和颞叶内侧结构。6例"皮质发育不良"患者中4例行皮质切除术,2例行异常皮质和颞叶内侧结构切除。5例"蛛网膜囊肿"均行囊肿切除术。术后随访3~8年,Engel-I级33例、II级8例、III级4例、IV级1例。本文通过分析得出,颞叶结构异常、海马硬化是儿童颞叶癫痫的主要致痫病因,手术切除"异常结构"及周围致痫皮质,能取得满意的癫痫控制效果。     

神经导航联合亚甲蓝染色切除海绵状血管瘤1例北大核心CSCD

颅内微小病变的手术治疗中,神经导航联合其他辅助技术用以纠正术中导航漂移的缺陷。报告1例神经导航联合亚甲蓝染色切除海绵状血管瘤。患者,男,56岁,因阵发性意识不清5年入院。神经系统查体未见明显阳性体征,右手及手臂可见烫伤瘢痕(患者做饭时出现短暂意识丧失,不慎手掌及手臂烫伤)。颅脑MR示左侧颞叶深部异常信号,考虑为颅内海绵状血管瘤。诊断:左颞叶海绵状血管瘤;继发性癫痫。予以神经导航联合亚甲蓝下行手术实现肿瘤的完全切除。术后好转出院,随访未再出现癫痫发作。     

经侧裂入路切除颞叶内侧病变

目的 探讨经侧裂入路治疗颞叶内侧病变的适应证及手术效果.方法 对2005年7月至2009年7月采用经侧裂入路治疗的26例颞叶内侧病变进行回顾性分析,了解其手术结果和手术并发症.结果 海绵状血管瘤6例,胶质瘤7例,胶质增生1例,海马硬化12例.海马硬化患者切除全部杏仁核及2.5～3.0 cm的海马组织.海绵状血管瘤合并癫痫者除切除病灶及附近的含铁血黄带和胶质瘢痕外,还切除周围部分正常海马组织.胶质瘤全切5例,2例次全切.脉络膜前动脉损伤致偏瘫1例,术区血肿1例,动眼神经损伤1例,视野缺损11例.结论 经侧裂入路切除颞叶内侧病变临床疗效满意,严重并发症少.     

难治性颞叶癫痫的外科治疗(附35例临床分析)

目的总结并分析难治性颞叶癫痫患者术前定位、手术方式和经验。方法回顾性分析2009年6月至2011年6月,采用颞前叶+海马杏仁核切除术治疗的颞叶癫痫病人35例,其中术前MRI及术后病理证实伴有海马硬化者32例,所有病例术中均在皮层电极监测下切除颞叶皮质及同侧海马、杏仁核,手术后均应用抗癫痫药物治疗,术后随访1～3年。结果在35随访病例中,癫痫发作控制结果显示EngelⅠ级24例,Ⅱ级8例,Ⅲ级3例,Ⅳ级0例。其中有12例病人术后2年逐渐停用抗癫痫药物。结论联合应用VEEG、MRI及EcoG能准确确定致痫灶,提高颞叶癫痫手术疗效。手术方式选择及显微理念的应用,能有效减少术后并发症的发生,避免出现永久性神经功能缺失。     

以癫痫起病的颞叶海绵状血管瘤的手术治疗

目的 探讨以癫痫起病的颞叶海绵状血管瘤的临床特征、显微手术治疗方法及效果。方法 对14例以癫痫起病的颞叶海绵状血管瘤的临床资料、手术方式和手术效果进行回顾性分析。结果 6例单纯瘤周放电和1例电极描记阴性行单纯病变和含铁血黄素层切除;7例病变侵及颞叶内侧和岛叶,加行前颞叶以及内侧结构切除术。术后随访1~2年,癫痫缓解率满意,按照Engel 癫痫手术预后标准,Ⅰ级8例,Ⅱ级4例,Ⅲ级1例,Ⅳ级1例;所有患者未检测到血管瘤复发。结论 对颞叶海绵状血管瘤继发癫痫,术前积极评估,采取个体化手术方案,争取血管瘤和含铁血黄素层全切,同时恰当处理好存在的致痫灶,是治愈海绵状血管瘤和控制癫痫发作的有效手段。     

磁共振波谱分析与液体衰减反转恢复成像在诊断海马硬化中的作用分析

目的通过对23例颞叶癫痫病人的磁共振波谱分析(magnetic resonance spectroscopy,MRS)与液体衰减反转恢复(nuid attenuated inversion recovery,FLAIR)序列成像结果进行分析,探讨其在诊断海马硬化中的作用与意义。方法经手术治疗的23例颞叶癫痫病人,术中皮层电极及深部电极、术后病理检查结果证实为外侧型癫痫6例,海马硬化型17例,分析其术前磁共振T1、T2、FLAIR序列、MRS检查结果。结果6例颞叶外侧型癫痫海马区T1、T2、FLAIR序列、MRS检查均无异常,17例海马硬化型中6例T1、T2显示异常,7例FLAIR序列高信号,16例MRS显示氮-乙酰天冬氨酸(N—acetylaspantate,NAA)峰明显下降,其中1例显示双侧NAA峰下降。结论MRS可在MRI出现改变之前发现海马硬化,其诊断海马硬化灵敏且特异性高,FLAIR序列优于T2加权相,MRS与FLAIR序列是海马硬化术前诊断一个可靠的方法。     

From swelling to sclerosis: acute change in mesial hippocampus after prolonged febrile seizure.

Mesial temporal sclerosis (MTS) has been linked to prolonged febrile seizures. The sequence of changes in the temporal lobe/hippocampus following prolonged febrile seizures and status epilepticus is beginning to be elucidated. We obtained repeated magnetic resonance imaging (MRI) volumetric analysis of the hippocampi in a 23-month-old boy after a prolonged focal febrile seizure. Three days after a prolonged left focal febrile seizure, brain MRI showed increased T2 weighted signal and increased volume (swelling) of the right hippocampus. Repeat MRI 2 months later demonstrated sclerosis of the right hippocampus. Review of the literature shows four other children with prolonged focal seizures associated with the MRI sequence of temporal lobe swelling followed by sclerosis. All had left focal seizures followed by right MTS. Our patient demonstrates a shorter interval for the radiologic development of hippocampal sclerosis compared to other reports.     

海绵状血管瘤致颞叶内侧癫痫手术入路选择

目的探讨引起癫痫的颞叶内侧不同部位海绵状血管瘤（cA）的手术入路选择。方法对3例位于颞叶内侧不同部位CA导致癫痫发作的患者,分别采取经侧裂入路、颞上沟入路及颞下回入路手术切除病灶。结果所有病例术中病灶显露满意,均予以完全切除。术后随访4～8个月,3例患者均无癫痫发作。结论对位于颞叶内侧不同部位的CA应根据病灶的部位选择不同手术入路,有利于充分显露并完全切除病灶。     

Relation of sorting impairment to hippocampal damage in temporal lobe epilepsy

One hundred and twelve patients with left (n=65) or right (n=47) temporal lobe epilepsy (TLE), associated with mesial or lateral temporal lobe lesion, were compared to 53 patients with left (n=30) or right (n=23) frontal lobe epilepsy (FLE), in order to explore the contributions of hippocampal lesions and of memory deficits to sorting impairment. Thirty-six healthy subjects of similar age and education were controls. The Modified Wisconsin Card Sorting Test (MWCST) was used to explore sorting ability. The two-syllable word span and consistent long-term retrieval from the selective reminding procedure for word-list learning were used to evaluate memory. Raven's Coloured Progressive Matrices and Attentive Matrices served to control for abstract reasoning and attention. Left FLE patients and TLE patients with left hippocampal sclerosis were significantly impaired on MWCST, short-term memory, and word learning. TLE patients with other left hippocampal lesions were also impaired on MWCST, although not significantly so. Analysis of individual scores showed that 42% of TLE patients with left hippocampal sclerosis, 14% of TLE patients with other hippocampal lesions, 63% of left FLE patients, and 30% of right FLE patients were impaired on the MWCST. In patients with left hippocampal sclerosis, MWCST score was associated with the learning score provided by the selective reminding procedure and Raven's Coloured Progressive Matrices score, whereas in FLE patients, MWCST score was associated with Attentive Matrices score. These results suggest that only some TLE patients, i.e. those with hippocampal damage, may be expected to be impaired on card sorting. The impaired sorting ability of these TLE patients may be due to involvement of the hippocampal function in forming associations or in registering new information.     

Verbal learning and forgetting in patients with temporal lobe epilepsy

Studies comparing non-surgical patients with left or right temporal lobe epilepsy (TLE) have shown irregular differences in verbal learning and memory. We assessed the performance of unoperated patients with epileptogenic temporal lobe lesions or cryptogenic TLE using a selective reminding procedure for the learning of a word list, and five delayed trials for the recall of learned words. On the selective reminding procedure, patients with left TLE were found to be more impaired than those with right TLE and controls, in agreement with the role of the left temporal lobe in verbal learning. The patients with right TLE were more impaired than the controls, possibly due to the semantic organization of the word list The rate of forgetting learned words was similar in the patient and control groups, suggesting that patients with left TLE can normally retain and/or retrieve stored items. These data support the hypothesis that distinct functional systems subserve learning and memory. Comparisons of the patient subgroups with epileptogenic lesions (hippocampal sclerosis or low-grade glioma) and those with cryptogenic TLE did not reveal any significant difference in learning or in memory, suggesting that epileptiform activity could affect verbal performance as a detectable temporal lesion.     

Temporopolar changes in temporal lobe epilepsy: a quantitative MRI-based study

OBJECTIVES: To quantify the morphologic changes of temporopolar structures to better understand the pathophysiology of anterior temporal white matter increased T2 signal observed in temporal lobe epilepsy (TLE). METHODS: MRI was performed in 30 patients with TLE and in 30 normal control subjects and independently assessed by visual analysis and quantitative measurements. Specifically, the temporal pole (TP) volume, as well as its gray and white matter components, was measured using three-dimensional T1 MR images and a semiautomatic protocol. The authors tested whether the presence of an increased T2-weighted signal in the anterior temporal white matter was associated with significant TP atrophy. The associations between the TP volume and MRI signs of hippocampal sclerosis, age at onset, seizure frequency, duration of illness, and a history of febrile convulsions were also studied. RESULTS: Both right and left TLE populations demonstrated a reduction of the temporopolar white and gray matter volumes ipsilateral to seizure onset (p < 0.02 in right TLE; p < 0.0001 in left TLE). Twenty-two patients (72%) exhibited significantly abnormal TP volume measurements, which correctly lateralized the epileptogenic zone in all cases. The presence of an increased T2-weighted signal in the anterior temporal white matter (ISWM), but not that of hippocampal sclerosis, was associated with a greater TP volume asymmetry index (p < 0.05). CONCLUSIONS: The temporal pole is frequently atrophic ipsilateral to seizure onset in refractory TLE. The association between TP atrophy and ISWM suggests that both abnormalities might derive from a common pathologic process.     

Face memory in MRI-positive and MRI-negative temporal lobe epilepsy

PURPOSE: Effects of MRI-positive (MRI(+)) as compared to MRI-negative (MRI(-)) temporal lobe epilepsy (TLE) on face memory are not yet known. METHODS: We studied 24 MRI(-) (11 right/13 left) and 20 MRI(+) (13 right/7 left) TLE patients, 12 generalized epilepsy patients, and 12 healthy subjects undergoing diagnostic workup with 24-72-h Video-EEG-monitoring. Twenty faces were shown, and had to be recognized from 40 faces immediately and after a 24-h delay. RESULTS: MRI(+) and MRI(-) right TLE (RTLE) patients showed deficits in face recognition compared to controls or generalized epilepsy, consistent with right temporal lobe dominance for face recognition. MRI(+) RTLE patients had deficits in both immediate and delayed recognition, while MRI(-) RTLE patients showed delayed recognition deficits only. The RTLE groups showed comparable delayed recognition deficits. Separate analyses in which the MRI(+) group included patients with hippocampal sclerosis only, did not alter results. Furthermore, MRI(-) RTLE had a worse delayed recognition than MRI(-) left TLE (LTLE). On the other hand, MRI(+) RTLE did not differ from MRI(+) LTLE in delayed recognition. Combining MRI(-) and MRI(+) TLE groups, we found differences between RTLE and LTLE in delayed, but not immediate face recognition. CONCLUSIONS: Our results suggest that a delayed recognition condition might be superior to immediate recognition tests in detecting face memory deficits in MRI(-) RTLE patients. This might explain why former studies in preoperative patients did not observe an immediate face recognition dominance of the right temporal lobe when combining MRI(-) and MRI(+) TLE patients. Our data further point to an important role of the right mesial temporal region in face recognition in TLE.     

颞叶癫患者的头颅磁共振显像异常表现分析

目的对颞叶癫(TLE)患者头颅磁共振成像(MRI)异常表现进行分析,为临床诊治TLE提供参考。方法对56例TLE患者的头颅MRI异常表现进行分析总结。结果 56例TLE患者头颅MRI主要表现为海马硬化、颞叶软化灶、颞叶肿瘤、颞叶皮质萎缩等。其中,颞叶肿瘤类型多样,主要为少突胶质瘤、星形细胞瘤、脑膜瘤。结论 TLE患者头颅MRI异常表现复杂多样,正确掌握其特点有助于TLE的诊治。     

Contralateral temporal hypometabolism on positron emission tomography in temporal lobe epilepsy

Introduction — No detailed case studies report lateralised hypometabolism on positron emission tomography (PET) contralateral to the epileptogenic focus in temporal lobe epilepsy (TLE). Material and methods — We performed ¹⁸F fluorodeoxyglucose (FDG) PET in two intractable TLE patients. Results — One had right temporal interictal spikes on electroencephalography (EEG) and a right medial temporal lobe lesion on magnetic resonance imaging (MRI). FDG-PET showed decreased uptake in the left temporal lobe. Right temporal ictal onset, with bilateral interictal epileptiform activity, occurred on intracranial EEG. He is seizure free after right temporal lobectomy and ganglioglioma resection. The second had right temporal lobe interictal and ictal EEG activity. MRI demonstrated right anteriomedial temporal increased T2 signal. Neuropsychology revealed bilateral cognitive dysfunction. FDG-PET showed left anterior temporal and lateral frontal hypometabolism. He is seizure free after right temporal lobectomy. Conclusion — These findings suggest that regional uptake asymmetry on FDG-PET may be give misleading lateralising information in TLE.     

Wisconsin Card Sorting performance in patients with temporal lobe epilepsy: clinical and neuroanatomical correlates

PURPOSE: A sizable proportion of patients with temporal lobe epilepsy (TLE) display impairments on tests of executive function. Previous studies have suggested several factors that may explain such performance, including the presence of hippocampal sclerosis, electrophysiological disruption to extratemporal regions, and early age of seizure onset. However, no clear determinants have been found that consistently explain such executive dysfunction. The present study investigated the contribution of several clinical variables and temporal lobe neuroanatomic features to performance on the Wisconsin Card Sorting Test (WCST) in a series of patients with TLE. METHODS: Eighty-nine patients with lateralized TLE (47 left, 42 right) were examined. Seventy-two patients from this series underwent anterior temporal lobectomy (ATL). Regression analysis was used to examine the effects of age, education, age at seizure onset, seizure duration, seizure laterality, history of secondary generalized seizures, and MRI-based volumes of the right and left hippocampi on preoperative WCST performance (number of categories completed, perseverative errors). Further univariate analyses examined whether the presence of bilateral hippocampal sclerosis, mesial temporal lobe abnormalities beyond the hippocampus, or temporal neocortical abnormalities affected preoperative WCST performance. In addition, we examined whether becoming seizure free after ATL affected change in WCST performance. RESULTS: Overall regression analysis was not significant. However, an examination of individual partial correlations revealed that patients with a history of secondary generalized seizures performed more poorly on the preoperative WCST than did patients without such history. In addition, patients who were seizure free after ATL did not exhibit better WCST outcome than patients who did not become seizure free. The presence of bilateral hippocampal sclerosis, extrahippocampal mesial temporal atrophy, or temporal neocortical lesions did not affect WCST performance. CONCLUSIONS: These results indicate that the presence of temporal lobe structural abnormalities do not significantly affect executive function as measured by the WCST. The present study does suggests that the critical determinants of WCST performance in patients with TLE lie outside the temporal lobe and likely relate to metabolic disruption to frontostriatal neural network systems.