显微切除痫灶治疗颞叶顽固性癫痫的疗效分析

目的总结显微切除痫灶治疗颞叶顽固性癫痫的临床疗效。方法颞叶顽固性癫痫24例,手术采用改良翼点入路切口,运用良好的显微外科技术,将癫痫灶切除。结果术后随访半年至3年,16例癫痫发作完全消失,4例术后较术前显著改善,2例术后效果良好,手术总有效率91.7%(22/26)。结论根据脑电监测范围显微切除痫灶治疗颞叶顽固性癫痫是安全、有效的手术方式,辅以综合治疗术后并发症少,疗效满意。     

蛛网膜囊肿伴癫痫的处置探讨

总结2001年1月-2007年3月．首发症状为癫痫发作／伴有癫痫发作的侧裂区蛛网膜囊肿患者12例的手术经验。1年及1年以上的随访结果，报道如下。     

颞叶癫痫12例外科手术治疗

总结2000-03-2003-12用外科手术治疗的42例癫痫患者中属颞叶癫痫患者12例，报告如下。     

单侧颞叶切除治疗颞叶癫痫20例疗效分析

颞叶癫痫是指致痫灶位于颞叶的癫痫,约占难治性癫痫的60%,颞叶切除是治疗难治性癫痫的一种经典、实用的手术方法,治疗效果好,经术后随访,70%患者术后效果优良。随着诊断与手术技术的改善,有效率可达90%以上。致痫灶的准确定位始终是癫痫外科     

难治性颞叶癫痫83例的手术治疗分析

目的:探讨难治性颞叶癫痫(ITLE)的外科治疗方法和效果。方法:83例ITLE患者,术前均行EEG、MRI检查,其中23例行PET,19例行SPECT检查。经测定位后,行手术治疗。其中30例行标准前颞叶切除,37例行标准前颞叶切除 胼胝体切开,16例行病灶切除 致痫灶切除。术中应用皮层电极或深部电极进行检测,并在显微镜下操作。结果:满意47例(56.6%),显著改善23例(26.5%),良好13例(15.6%)。术后无明显并发症,效果良好。结论:手术是ITLE的主要治疗手段,海马硬化和微血管畸形可能是ITLE发生的主要原因。     

颅内蛛网膜囊肿的手术治疗

目的探讨颅内蛛网膜囊肿(IAC)的临床特点及治疗方法。方法对我科手术治疗19例颅内蛛网膜囊肿进行回顾性分析总结。结果本手术组所有患者均恢复良好,无死亡病例,复查CT或MRI15例囊肿消失或缩小,4例变化不明显,术前颠痫患者,得到控制或发作次数减少。结论对确诊的颅内蛛网膜囊肿,积极的手术能有效地改善患者的临床症状体征,是较为安全和可行的方法。     

颅内蛛网膜囊肿手术方式的探讨

自１９９３年２月～１９９８年４月我科共收治颅内蛛网膜囊肿２０例,采取了不同手术方法,治疗效果满意,现报告如下。１临床资料１１一般资料男１６例,女４例。年龄３～５５岁,平均２１９岁,其中２０岁以下１２例。囊肿发生部位：外侧裂池９例,枕大池７例,小脑...     

颞叶癫痫的MRI研究

研究颞叶癫痫患者的ＭＲＩ表现，并测量ＴＬＥ患者海马结构的体积以确定癫痫灶的侧别。在１．０ＴＭＲ机对３８例ＴＬＥ患者进行研究，用正中矢状面定位，作平行于脑干的倾斜冠状面Ｔ１和Ｔ２加权像。在所有的倾斜冠状面Ｔ１加权像上手工描出ＨＰＦ的边界，把所有层在的体积相加即得到ＨＰＦ的体积，并进行标准处理以消除头颅大小的影响。     

手术治疗颅内蛛网膜囊肿45例

蛛网膜囊肿(ICA)约占颅内占位性病变的1%[1],自1995年5月至2003年12月期间收治的45例颅内蛛网膜囊肿,并讨论如下。1资料与方法1.1一般资料男30例,女15例。年龄2岁~52岁,20岁以下25例。病程1月~12年不等。13例有头部外伤史,外伤至发病时间:10天~4年不等。ICA发生部位:外侧裂池22     

手术治疗颅内蛛网膜囊肿45例

目的:报告45内蛛网膜囊肿(IAC),对其临床表现.诊断.手术适应证.手术方法选择和术中注意事项进行了讨论。方法:回顾性分析我院1995年5月~2003年12月收治的45例颅内蛛网膜囊肿。结果:手术45例在术后囊腔均缩小或消失,颅高压解除,症状消失。结论:ICA约占颅内占位性病变的⒈17%,最常见于外侧裂池。CT.MRI是最可靠的诊断方法。凡囊肿有颅内高压者,充分建立囊腔与周围脑池或腹腔之间的交通是手术成功的关键。     

MR imaging of middle cranial fossa arachnoid cysts: temporal lobe agenesis syndrome revisited

MR studies in eight patients with extraaxial arachnoid cysts in the middle cranial fossa were reviewed in order to identify any associated structural defect in the ipsilateral temporal lobe. The study was prompted by the original theory that agenesis of the temporal lobe is the primary factor in the development of these cysts. Authors of subsequent studies proposed that the cysts are a consequence of embryological malformation of the meninges only and that the adjacent temporal lobe is compressed. Our findings suggest that middle cranial fossa cysts are associated with temporal lobe hypogenesis, and also that compression of the temporal lobe is an infrequent accompaniment.     

Developmental abnormalities of the medial temporal lobe in patients with temporal lobe epilepsy.

PURPOSETo evaluate MR temporal lobe malformations and their frequency in patients with temporal lobe epilepsy.METHODSTwo hundred twenty-two consecutive adult patients with temporal lobe epilepsy of varying severity were investigated with 1.0-T or 1.5-T MR units using three-dimensional T1-weighted acquisition protocol.RESULTSSixteen patients (7.2%) presented with malformations of the temporal lobe. Four patterns of malformations were encountered: (a) heterotopia (n = 1), lining the temporal horn of the lateral ventricle; (b) focal neocortical dysgenesis (n = 6), which consisted of cortical thickening, poor gray/white matter demarcation, abnormal gyration (n = 5), or limited schizencephaly (n = 1); (c) hippocampal malformations (n = 5), which presented as abnormal hippocampal formation associated with a cyst (n = 2), isolated malformation of the subiculum (n = 1), or bilateral hippocampal malformation (n = 2) consisting of an abnormal shape and a misplaced fimbria; (d) complex malformations of the temporal lobe, combining categories a, b, and c (n = 4). The age at onset, severity of the disease, and occurrence of generalized tonicoclonic seizures were not significantly different between patients with malformations and the entire population of patients with temporal lobe epilepsy.CONCLUSIONMR analysis of temporal lobe malformations allowed a precise determination of the extent of the malformations and the presence or absence of associated hippocampal disease, all of which are of great help in the preoperative evaluation of patients with intractable epilepsy.     

额叶脑挫裂伤伴额眶前颅底骨折的显微手术治疗

目的探讨额叶脑挫裂伤伴额眶前颅底骨折的显微手术治疗方法及效果。方法回顾性分析18例额叶脑挫裂伤伴额眶前颅底骨折的临床表现与手术治疗效果。其中男性16例,女性2例;年龄35~68岁,平均41.5岁。致伤原因:道路交通伤9例,异物撞击伤7例,坠落伤1例,击打伤1例。入院时GCS评分13~15分3例,9~12分7例,5~8分8例。18例患者均行开颅显微镜下挫裂伤组织及血肿清除术,一期前颅底重建修补术,其中3例行一期视神经管减压术。结果随访6个月~2年,GOS评分5分11例,4分5例,3分1例;死亡1例。术后早期脑脊液漏2例,经非手术治疗均在2周内脑脊液漏消失。3例视力障碍患者有1例术后视力改善。结论早期彻底清创,显微镜下彻底清除额叶失活挫裂伤组织及血肿,严密缝合硬脑膜,尽量恢复额眶前颅底骨质完整,视神经损伤患者一期视神经管减压,术后综合治疗,可减少神经功能障碍,改善患者预后。     

EEG-fMRI using z-shimming in patients with temporal lobe epilepsy

PURPOSE: To use z-shimming, a technique that reduces signal loss due to susceptibility artifacts that can result in reduced or absent activation in electroencephalography (EEG) functional MRI (fMRI) sessions in patients with temporal lobe epilepsy (TLE), to determine whether it would result in an increased ability to detect significant regions of blood oxygenation level-dependent (BOLD) signal change. MATERIALS AND METHODS: Eight patients with TL EEG spikes underwent an EEG-fMRI scanning session using z-shimming. The signal intensities in the z-shimmed images were compared with those in the standard images. BOLD activation maps were created from the two sets of images using the timings of the spikes observed on the EEG. RESULTS: The mean signal increase in the TLs as a result of z-shimming was 45.9%+/-4.5%. The percentage of TL voxels above a brain intensity threshold rose from 66.1%+/-7.6% to 77.6%+/-5.7%. This appreciable increase in signal did not lead to any significant differences in the statistical maps created with the two sets of functional images. CONCLUSION: The results suggest that loss of signal is not the limiting factor for the detection of spike-related BOLD signal changes in patients with TLE activity.     

Brain SPECT imaging in temporal lobe epilepsy

Summary Temporal lobe epilepsy is diagnosed by clinical symptoms and signs and by localization of an epileptogenic focus. A brain SPECT study of two patients with temporal lobe epilepsy, using^99mTc-HMPAO, was used to demonstrate a perfusion abnormality in the temporal lobe, while brain CT and MRI were non-contributory. The electroencephalogram, though abnormal, did not localize the diseased area. The potential role of the SPECT study in diagnosis and localization of temporal lobe epilepsy is discussed.     

Dynamic perfusion patterns in temporal lobe epilepsy

Purpose  To investigate dynamic ictal perfusion changes during temporal lobe epilepsy (TLE). Methods  We investigated 37 patients with TLE by ictal and interictal SPECT. All ictal injections were performed within 60 s of seizure onset. Statistical parametric mapping was used to analyse brain perfusion changes and temporal relationships with injection time and seizure duration as covariates. Results  The analysis revealed significant ictal hyperperfusion in the ipsilateral temporal lobe extending to subcortical regions. Hypoperfusion was observed in large extratemporal areas. There were also significant dynamic changes in several extratemporal regions: ipsilateral orbitofrontal and bilateral superior frontal gyri and the contralateral cerebellum and ipsilateral striatum. Conclusion  The study demonstrated early dynamic perfusion changes in extratemporal regions probably involved in both propagation of epileptic activity and initiation of inhibitory mechanisms.     

Morphological abnormalities of limbic lobe structures in partial temporal lobe epilepsy

PURPOSE: To evaluate lesions of the different structures of the Papez circuit in association with hippocampal sclerosis. MATERIAL: and methods. 13 patients (32.1+/-8.2 y.o.) suffering from partial, temporal lobe, drug-resistant epilepsy and 20 normal volunteers (31.8+/-7.7 y.o.) were evaluated by MRI on a 1.5 T scanner (Philips): axial T1w 3D Gradient Echo acquisitions, thickness: 1.5mm. Hippocampus and cingulate gyrus volume were calculated after semi-automated segmentation of intrasulcal gray matter using the "Surgiscope Scopeplan" Elekta((R)). The thickness of the posterior column of the fornix and the thickness of the mamillary bodies were also measured. RESULTS: We found 10 cases of ipsolateral hippocampal sclerosis, 6 cases of ipsolateral atrophy of the mamillary body and 4 cases of ipsolateral atrophy of the fornix. We did not find any atrophy of the cingulate gyrus. CONCLUSION: Hippocampal sclerosis can be associated with lesions of limbic lobe structures (fornix and mamillary body), excluding the cingulate gyrus.     

难治性颞叶癫痫的分子影像学研究与病理对照

目的:对照难治性颞叶癫痫(TLE)手术病理资料,探讨联合单光子发射计算机断层(SPECT)和质子磁共振波谱(1 H-MRS)两种分子影像学技术对TLE定位的临床价值。方法:选择29例经手术病理证实的单侧TLE。所有患者术前均行SPECT发作间期脑血流(CBF)灌注显像、常规磁共振(MRI)扫描和1 H-MRS成像。将两种分子影像学技术,发作间期CBF灌注显像和1 H-MRS,对TLE的定位表现与病理结果进行对比分析。结果:病理改变最常见的是海马硬化和皮质发育不良,共27例(93.10%),此两种改变伴随出现于16例中(55.17%)。对于双重病理TLE,MRI、SPECT定位阳性率均为100%(16/16),MRS为87.50%(14/16)。对于单纯性海马硬化,MRI为阴性,SPECT仅为14.29%(1/7),而MRS高达57.14%(4/7)。对于单纯性皮质发育不全,MRS为阴性,MRI为50.00%(2/4),而SPECT高达75.00%(3/4)。联合应用SPECT和MRS对TLE定位率高达86.20%(25/29),尤其是对MRI阴性的患者,两种技术联合能发现54.55%(6/11)TLE的致痫灶。结论:联合SPECT发作间期脑血流灌注显像和1 H-MRS两种分子影像学技术能为难治性TLE提供更为全面和准确的定位诊断信息,可进一步提高定位MRI阴性TLE患者致痫灶的比例。     

MRI of hippocampal malformations in patients with intractable temporal lobe epilepsy

OBJECTIVE: In some patients with temporal lobe epilepsy, recent MRI studies have revealed several morphological features indicative of discrete hippocampal malformation (HM). Its prevalence is unknown and the relationship between the HM and the origin of seizures has never been investigated. Our purpose is to define the MRI findings of this new entity and to determine its incidence in a group of patients and in a control group in order to evaluate its clinical significance. MATERIALS AND METHODS: MR imaging findings in 97 patients suffering from medically intraceable temporal epilepsy were prospectively evaluated during the preoperative evaluation of surgical candidates. The MR-imaging protocol included oblique coronal slices perpendicular to the temporal lobes using high resolution T2 weighted (HR TSE T2), Fluid attenuated inversion recovery (FLAIR) and inversion-images. This protocol has been completed by axial FLAIR images and axial and sagittal IR images of the whole brain. Coronal HR TSE T2 images were performed in 50 healthy control subjects. Cerebral lesion and hippocampal morphology were evaluated in both groups. RESULTS: Fourteen patients (14%) showed hippocampal morphological modification. The most frequent and specific findings were lack of visualization of the internal hippocampal (lack of linear T2 hypointensity within the hippocampus) and the abnormal shape (pyramidal, vertically oriented or globular-shaped). Other signs were: abnormal position of the hippocampus (medically located hippocampus) and vertical collateral sulcus. Cases without visualization of the internal structure of the hippocampus were considered as a complete form of HM and were correlated with temporal epilepsy. A vertical collateral sulcus was observed in some control group subjects. CONCLUSION: Complete forms of HM could be considered as epileptogenic lesions. Nevertheless, interpretation of the incomplete form is delicate: the abnormal angle of the collateral sulcus can be encountered in healthy subjects and could therefore be considered a normal variant.