立体定向毁损术治疗颞叶顽固性癫的护理

目的探讨立体定向手术治疗颞叶顽固性癫的临床观察及护理要点。方法12例颞叶顽固性癫患者行立体定向手术治疗,术前进行充分的心理护理及术前准备;术后严密观察病情,着重加强安全保护措施及癫发作的监测及护理;强化癫的康复护理健康指导。结果术后半年以上随访,7例患者疗效满意,4例疗效显著,1例疗效较差,本组患者的有效率为91.7%(11/12)。结论立体定向手术治疗颞叶顽固性癫效果良好,其术前心理护理及完善的术前准备是手术治疗的基础护理措施,术后的病情观察及细致的护理是关键,健康指导对确保手术疗效、促进康复起着重要的作用。     

幕上胶质瘤致癫相关因素分析

目的探讨幕上胶质瘤致癫相关因素。方法回顾性分析175例幕上胶质瘤病人的临床资料,其中伴发癫51例(29.1%);并对肿瘤部位、影像学特点、侵犯皮质及病理类型等致癫相关因素进行统计分析。结果额叶胶质瘤癫发生率明显高于其他部位胶质瘤(P0.01),少枝胶质细胞瘤及低级别星形细胞瘤易于发生癫(P0.017),肿瘤侵犯皮质病人癫发生率明显高于未侵犯皮质者(P=0.01)。结论幕上胶质瘤伴发癫与肿瘤所在部位、病理类型及侵犯皮质相关。对于此类病人不仅需手术切除肿瘤,还应控制癫发作,减少并发症,提高生存质量。     

神经皮肤黑变病合并部分性癫

目的讨论神经皮肤黑变病(NCM)合并部分性癫的手术治疗及效果。方法回顾性分析1例NCM合并癫病人的临床资料。皮质电极监测后,行颞极及颞叶新皮质部分切除术。结果术后脑组织病理提示:颞极见大量黑色素细胞,原发性脑膜黑色素细胞增生症。皮肤病理提示复合性色素痣。术后10个月无癫发作。Engel分级Ⅰ级。结论 NCM是癫的罕见原因,但手术治疗效果满意。致灶切除术是一种安全有效的治疗方法。     

颞叶癫(癎)影像诊断和脑电图分析

目的探讨CT和脑电图(EEG)对颞叶癫的诊断作用。方法分析使用美国GE1800型CT机及ND-82B型EEG仪监测的28例颞叶癫。结果CT检查正常6例(21.4%),异常22例(78.6%)。EEG记录间歇期样发作19例,临床发作期9例。结论CT结合EEG对颞叶癫的诊断、定位具有重要意义。     

外伤后癫的致灶定位和手术治疗

目的总结外伤后癫的诊治经验。方法回顾性分析55例经手术治疗的外伤后癫病人的临床资料。术前病人均行视频脑电图(VEEG)和MRI检查,行脑磁图(MEG)检查8例,行颅内电极植入4例,行Wada试验4例。行病灶及周边致皮质切除术23例,行病灶及周边致皮质切除加功能区致皮质低功率热灼术30例,行解剖性半球切除术2例。结果术后随访55例,时间1～4年,根据Engel分级:Ⅰ级40例(72.7%),Ⅱ级10例(18.2%),Ⅲ级5例(9.1%)。结论外伤后癫病人如经药物治疗效果不佳,在明确致区及选择合适手术方法的前提下,可取得良好效果。     

重型颅脑损伤继发外伤性癫103例临床分析

目的分析重型颅脑损伤继发外伤性癫形成的原因、发病机制,以及外伤性癫的预防措施。方法对重型颅脑损伤患者救治过程中继发外伤性癫的临床特点和治疗结果进行回顾分析。结果 946例重型颅脑损伤病人继发性癫103例,发生率10.9%。其中颅骨凹陷粉碎性骨折39例(37.9%),开放性颅脑损伤28例(27.2%),颅内血肿25例(24.3%),单纯脑挫裂伤11例(10.7%)。结论重型颅脑损伤继发外伤性癫是局部严重的脑神经细胞结构损伤和神经抑制、负反馈系统破坏,导致神经细胞异常过度放电和异常放电进一步扩展形成的。     

外伤后癫(癎)的致(癎)灶定位和手术治疗

目的总结外伤后癫的诊治经验。方法回顾性分析55例经手术治疗的外伤后癫病人的临床资料。术前病人均行视频脑电图(VEEG)和MRI检查,行脑磁图(MEG)检查8例,行颅内电极植入4例,行Wada试验4例。行病灶及周边致皮质切除术23例,行病灶及周边致皮质切除加功能区致皮质低功率热灼术30例,行解剖性半球切除术2例。结果术后随访55例,时间1～4年,根据Engel分级:Ⅰ级40例(72.7%),Ⅱ级10例(18.2%),Ⅲ级5例(9.1%)。结论外伤后癫病人如经药物治疗效果不佳,在明确致区及选择合适手术方法的前提下,可取得良好效果。     

脑血管病继发性癫的临床分析

目的研究急性脑血管病与癫的关系。方法对4年来586例经CT或MRI证实的40例脑血管病继发性癫的临床资料进行分析。结果脑血管病继发性癫发生率为6.8%(40/586),其中全身阵挛发作21例,部分发作11例,复杂部分发作3例,部分发作发展为全身强直发作3例,丘脑发作2例;2周内癫发作27.5%(11/40),2周后癫发作的72.5%(29/40),抗癫治疗88.6%有效。结论脑血管病是继发性癫的重要原因之一,它的发生率与病灶部位有明显的关系,抗癫治疗效果佳。     

岛周大脑半球离断术治疗药物难治性癫

目的探讨岛周大脑半球离断术治疗一侧半球性病变所致难治性癫的疗效与安全性。方法回顾性分析21例难治性癫的病例资料,均采用岛周大脑半球离断术。结果病理报告:Rasmussen脑炎7例,软化灶14例。术后随访2~4年,Engel分级:Ⅰ级18例(85.7%),Ⅱ级2例(9.5%),Ⅲ级1例(4.8%)。病人术后均可独立行走,病人认知及生活能力较术前改善,但无统计学差异(P0.05)。全部病人术后未出现严重神经功能损伤与死亡。结论岛周大脑半球离断术治疗半球性难治性癫手术疗效确定,是治疗半球病变性癫安全有效的方法。     

胚胎发育不良性神经上皮瘤与颞叶癫

目的探讨胚胎发育不良性神经上皮瘤（dysembryoplastic neuroepithelial tumor,DNT）相关颞叶癫的临床特点及外科治疗方法。方法回顾性分析21例颞叶癫DNT病人的临床资料,均以部分性癫起病,平均起病年龄轻。MRI上有典型的＂倒三角征＂和瘤内分隔表现。PET检查表现为病灶及周边脑皮质葡萄糖摄取减低。均行标准前颞叶切除术。结果术后随访1~6年,癫控制良好,无肿瘤复发病例。术后病理提示：单纯型DNT 6例,复杂型DNT 15例,伴局灶性脑皮质发育不良13例。结论应用标准前颞叶切除治疗癫相关的颞叶DNT,手术预后较好。     

Treatment outcome in patients with mesial temporal sclerosis.

The long-term prognosis of pharmacological therapy in patients with mesial temporal sclerosis (MTS) is generally considered poor. On the contrary, successful surgical therapy is frequently reported. We performed a retrospective case record survey of patients with MTS in a comprehensive epilepsy center between 1993 and 1999 in order to develop treatment strategies. The time period allowed access to high-resolution qualitative magnetic resonance imaging (MRI) and a minimum of 1-year outcome assessment. Eighty-three patients with intractable partial epilepsy with MRI and electroencephalograph (EEG) abnormalities and seizure semiology consistent with temporal lobe epilepsy were identified. Thirty-six patients were treated pharmacologically and surgically and 47 patients received only pharmacotherapy. The number of patients who became seizure free was in total 37 (45%); in the surgical group 26 and in the non-surgical group 11. The proportions of seizure-free patients in each group were 72% (surgical) and 23% (non-surgical). Clinical factors such as age, gender, lesion side, previous medical history, duration of illness, seizure frequency and IQ did not correlate to prognosis. A good seizure outcome was associated with early age of seizure onset, low number of previously used antiepileptic drugs (AEDs) and surgical treatment. There is a better long-term outcome in patients with MTS receiving surgical therapy in comparison with medical therapy.     

儿童期起病的颞叶癫痫术后疗效的预测因素分析

目的 探讨儿童期起病（起病年龄≤14岁）的颞叶癫痫术后疗效的预测因素。方法 回顾性分析2011年1月至2018年12月手术治疗的173例儿童期起病的颞叶癫痫的临床资料。术后随访12~101个月,平均（49.4±22.9）个月;末次随访采用Engel分级标准评估疗效,其中Ⅰ级为疗效良好,Ⅱ~Ⅳ级为疗效不佳。结果 173例中,Engel分级Ⅰ级135例（78.0%）,Ⅱ级8例（4.6%）,Ⅲ级20例（11.6%）,Ⅳ级10例（5.8%）。无严重手术相关并发症及手术死亡病例。多因素logistic回归分析显示,术前MRI显示脑部异常、热性惊厥史是儿童期起病的颞叶癫痫术后疗效良好的独立预测因素（P<0.05）。结论 儿童期起病的颞叶癫痫手术疗效良好。如果MRI显示脑部异常和/或伴热性惊厥史,建议采取手术治疗,可取得良好的效果。     

伽玛刀与手术治疗颞叶癫痫的疗效分析

目的探讨伽玛刀与手术治疗颞叶癫痫的疗效,寻求更佳的颞叶癫痫治疗方法。方法回顾性分析我院接受伽玛刀治疗颞叶癫痫患者35例,治疗边缘剂量15~25 Gy,接受手术治疗颞叶癫痫患者102例,随访患者治疗后癫痫控制情况。结果随访时间3~7年,平均4.5年,伽玛刀治疗组EngelⅠ级7例,EngelⅡ级8例,EngelⅢ级9例,EngelⅣ级11例,手术治疗组:EngelⅠ级69例,EngelⅡ级15例,EngelⅢ级10例,EngelⅣ级8例,两者差异有显著统计学意义(P0.0001)。结论手术治疗颞叶癫痫疗效显著优于伽玛刀治疗,伽玛刀术后癫痫缓解率低,并发症多,目前尚不能作为颞叶癫痫的常规治疗。     

中枢神经系统感染后继发难治性癫痫的病灶切除治疗

Previous studies have focused on medial temporal lobe epilepsy secondary to central nervous system infections. Several large-sample analyses of multi-lobe injuries or complications of medial temporal lobe epilepsy have been reported. The present study selected 29 patients (10 males and 19 females with a mean age of 18 years) with refractory epilepsy secondary to central nervous system infections (meningitis in 8, encephalitis in 21) from Beijing Functional Neurosurgical Institute from May 2006 to August 2008. All patients underwent computer tomography or magnetic resonance imaging, as well as electroencephalogram examinations; cortical electrodes were embedded in 11 patients. In addition, 13 (45%) patients underwent anterior temporal lobectomy, and 16 (56%) underwent extratemporal corcticectomy. Results showed that 18 (62%) patients obtained favorable outcomes following surgical treatment, including 80% with temporal lobe epilepsy and 50% with extratemporal epilepsy. Central nervous system infection was not a contraindication for epilepsy treatment, and identification of epileptic foci proved to be crucial. In addition, a young age at infection, as well as prolonged latent period from time of infection to initial afebrile seizure, were 2 predictive factors for all patients. Cortical electrodes significantly increased the detection rate of epileptic foci, but did not improve prognosis of foci excision.     

Electro-clinical characteristics and postoperative outcome of medically refractory tumoral temporal lobe epilepsy

BACKGROUND: Very few studies have specifically addressed surgical treatment and outcome of patients with tumor-related temporal lobe epilepsy (TLE). AIM: To define the postoperative seizure outcome and the factors that influenced the outcome of patients with tumor-related TLE. MATERIALS AND METHODS: We selected patients whose surgical pathology revealed a temporal lobe neoplasm and who had completed > 1 year of postoperative follow-up. We reviewed the clinical, EEG, radiological and pathological data, and the seizure outcome of these patients and assessed the factors that influenced the outcome. RESULTS: Out of the 409 patients who underwent surgery for refractory TLE during the 8-year study period, there were 34 (8.3%) patients with temporal lobe neoplasms. The median age at surgery was 20 years and the median duration of epilepsy prior to surgery was 9.0 years. MRI revealed tumor in the mesial location in 21 (61.8%) patients. Interictal and ictal epileptiform EEG abnormalities were localized to the side of th lesion in the majority. Mesial temporal lobe structures were included in the resection, if they were involved by the tumor; otherwise, lesionectomy alone was performed. During a median follow-up of 4 years, 27 (79%) patients were completely seizure-free. The only factor that predicted long-term seizure-free outcome was being seizure-free during the first two postoperative years. CONCLUSIONS: Our results emphasize the fact that in patients with tumoral TLE, when the seizures are medically refractory, surgery offers potential for cure of epilepsy in the majority.     

Surgical outcome and prognostic factors of cryptogenic neocortical epilepsy

Surgical treatment of cryptogenic neocortical epilepsy is challenging. The aim of this study was to evaluate surgical outcomes and to identify possible prognostic factors including the results of various diagnostic tools. Eighty-nine patients with neocortical epilepsy with normal magnetic resonance imaging (35 patients with frontal lobe epilepsy, 31 with neocortical temporal lobe epilepsy, 11 with occipital lobe epilepsy, 11 with parietal lobe epilepsy, and 1 with multifocal epilepsy) underwent invasive study and focal surgical resection. Patients were observed for at least 2 years after surgery. The localizing values of interictal electroencephalogram (EEG), ictal scalp EEG, interictal 18F-fluorodeoxyglucose positron emission tomography (FDG-PET), and subtraction ictal single-photon emission computed tomography were evaluated. Seventy-one patients (80.0%) had a good surgical outcome (Engel class 1-3); 42 patients were seizure free. Diagnostic sensitivities of interictal EEG, ictal scalp EEG, FDG-PET, and subtraction ictal single-photon emission computed tomography were 37.1%, 70.8%, 44.3%, and 41.1%, respectively. Localization by FDG-PET and interictal EEG was correlated with a seizure-free outcome. The localizing value of FDG-PET was greatest in neocortical temporal lobe epilepsy. The focalization of ictal onset and also ictal onset frequency in invasive studies were not related to surgical outcome. Concordance with two or more presurgical evaluations was significantly related to a seizure-free outcome.     

不同病程颞叶癫痫术后疗效及相关性分析

目的探讨不同病程颞叶癫痫患者术后疗效有无差异及手术疗效与病程有无相关关系。方法回顾性分析2002年1月-2011年1月在泸州医学院附属成都三六三医院神经外科接受手术治疗的颞叶癫痫患者183例,根据Engel分级评估分析不同病程患者术后疗效有无差异以及手术疗效与病程有无相关关系。结果早期手术治疗组术后无癫痫发作率占78．9％;中期手术治疗组术后无癫痫发作率占67．9％;晚期手术治疗组术后无癫痫发作率占58．6％。早期手术治疗组术后无癫痫发作率高于中期手术治疗组和晚期手术组,疗效差异有统计学意义（P〈0．05）;颞叶癫痫病程与术后疗效存在负相关关系（r=-0．213,P=0．002）,即病程越长,疗效越差。结论早期手术干预可能更加有利于控制癫痫发作,提高患者生存质量。     

From lateral to mesial: the quest for a surgical cure for temporal lobe epilepsy

PURPOSE: A gap of more than a hundred years occurred between the first accounts of mesial temporal sclerosis and recognition of its role in the pathogenesis of psychomotor seizures. This paper reviews how the understanding and surgical treatment of temporal lobe epilepsy developed, particularly from the work of Penfield, Jasper, and their associates at the Montreal Neurological Institute (MNI). METHODS: Publications on EEG and surgery for temporal lobe seizures from 1935 to 1953 were reviewed and charts of selected patients operated on at the MNI in the same period were examined. Attention was focused on the evolution of surgical techniques for temporal lobe epilepsy. RESULTS: In the late 1930s, some EEG findings suggested deep-lying disturbances originating in the temporal lobe. However, it took another two decades before the correlation of clinical, neurophysiological, and anatomical findings provided evidence for the involvement of the mesial structures in psychomotor or temporal lobe seizures. From 1949 and onward, Penfield and his associates applied this evidence to extend the surgical resections to include the uncus and the hippocampus. CONCLUSION: The collaborative work of a team led by Penfield and Jasper at the MNI helped to define the role of neurophysiological studies in epilepsy surgery. As a result, the importance of removing the mesial structures in order to obtain better seizure control in patients with temporal lobe epilepsy became firmly established.     

27例学龄前难治性颞叶癫痫患儿临床报道

目的探讨学龄前难治性颞叶癫痫患儿影像学、电生理特点及手术方法和疗效。方法回顾性分析解放军联勤保障部队第九八八医院神经外科中心自2014年6月至2019年1月行手术治疗的27例学龄前难治性颞叶癫痫患儿资料,术前评估结合临床发作表现,MRI、磁共振波谱分析(MRS)、正电子发射断层扫描(PET-CT)等影像资料,以及发作间期和发作期视频脑电图(VEEG)资料;术中应用皮层脑电图(ECoG)与深部电极监测定位异常放电区域,指导手术切除致痫灶范围。术后采用Engel分级评估疗效。结果27例患儿均有典型颞叶癫痫临床表现,MRI发现一侧颞叶及海马异常信号影,发作间期及发作期VEEG提示异常放电起始于一侧额颞部。术中ECoG及深部电极监测均发现颞叶明显持续或阵发性尖波、棘波、棘慢复合波等癫痫样放电。27例患儿均采用标准前颞叶+病灶切除+周边异常放电颞叶皮质扩大切除术,其中2例患儿切除部分岛叶长回及额盖皮质热灼处理。随访6个月,EngelⅠ级患儿22例,EngelⅡ级患儿3例,EngelⅢ级患儿2例。结论早期手术、术中ECoG与深部电极联合监测下适度扩大切除范围是改善学龄前难治性颞叶癫痫患儿手术疗效的关键因素。     

Frontal lobe epilepsy.

Frontal lobe epilepsy accounts for only 10-20% of the patients in surgical series, but the incidence in non-surgical patient cohorts seems to be much higher. The typical clinical presentation of the seizures includes contralateral clonic movements, uni- or bilateral tonic motor activity as well as complex automatism. The yield of surface EEG may be limited due to the difficulty in detection of mesial or basal foci, and the patient may be misdiagnosed as having non-epileptic events. In addition, in patients with mesial frontal foci the epileptiform discharges may be mislateralized ("paradoxical lateralization"). Therefore, epilepsy surgery has been commonly considered as less promising in patients with frontal lobe epilepsy. However, the advent of sophisticated neuroimaging techniques, particularly MRI with epilepsy-specific sequences, has made it possible to delineate the epileptogenic lesion and detect a specific etiology, in an increasing number of patients. Thus, the success rate of epilepsy surgery in frontal lobe epilepsy is currently comparable to temporal lobe epilepsy, if the candidates are carefully selected. Patients with frontal lobe epilepsy who do not respond to anticonvulsive medication, and who are not eligible for epilepsy surgery may benefit from alternative approaches such as electrical brain stimulation.