颞叶病灶性癫痫的手术治疗

目的 探讨颞叶病灶性癫痫（1esional temporal lobe epilepsy,LTLE）的术前评估及手术治疗方法。方法 回顾性地分析于我研究所接受癫痫手术治疗32例患者的临床资料,MRI与CT检查证实有结构性病灶存在且位于颞叶。根据手术预后将患者分为满意组与非满意组,对两组患者术前病灶特点、电生理情况及术后病理结果等因素进行统计分析。结果 32例LTLE患者中24例效果满意,术后满意率为75％,其中病灶为皮层发育障碍的17例,术后满意率为65％;病灶为肿瘤及其他病变的15例,术后满意率为87％。病灶位于标准前颞叶切除术范围之内的共21例,位于此切除范围之外的患者11例,前者的术后满意率高于后者（P〈0．05）;病灶位于颞叶内侧结构以内的患者8例,以外的患者24例,术后效果差异不显著（P〉0．05）。发作间期脑电图异常放电区域局限且位于病灶侧颞叶的患者,满意组中有19例,非满意组中有3例（P〈0．05）。结论 对于LTLE患者,手术治疗应为首选的治疗手段。手术前充分认识病灶的性质、部位以及神经电生理特点,对提高手术满意率有重要意义。     

多模态磁共振评估颞叶癫痫手术疗效

目前对颞叶癫痫(TLE)大多采取手术治疗,需要在术前、术后进行全面评估。目前多模态磁共振技术已用于评估术后癫痫疗效及术前、术后的语言、记忆功能。本文就多模态MR技术在TLE手术癫痫缓解评估以及认知功能评估中的研究进展进行综述。     

难治性颞叶癫痫的显微外科治疗

目的 总结显微外科手术治疗难治性颞叶癫痫的临床经验。方法 回顾性分析显微外科手术切除前颞叶50例颞叶癫痫的病例。结果 无死亡病例。术后随访半年至5年，症状发作完全消失25例，基本消失13例，发作次数减少50％或变型小发作9例，无效3例，有效率达95％。结论 应用显微外科技术切除前颞叶治疗颞叶癫痫可以明显减少并发症，提高临床疗效。     

颞叶癫痫的诊断和外科治疗

目的　探讨颞叶癫痫的诊断和治疗方法。　方法　利用EEG和MR对 3 0例颞叶癫痫(TLE)病例的癫痫灶进行定位诊断 ,依据诊断结果对其中 15例实施前颞叶切除术 ,另 15例接受选择性海马杏仁切除术 ,并分析其近期疗效及随访结果。　结果　 3 0例病例中手术疗效满意 18例 ;显著11例 ;良好 1例 ,术后无并发症发生。　结论　MR有助于对TLE的定位诊断 ;手术是治疗顽固性TLE的重要手段 ,对于EEG和MR提示为颞叶内侧癫痫的病例应选用选择性海马杏仁核切除 ,采用经颧弓颞底入路使手术更为安全。     

颞叶癫痫的外科治疗

癫痫是神经科常见的临床综合征。中国约有癫痫患者600多万,其中25％左右的患者经合理用药仍不能终止其发作,为难治性癫痫或称耐药性癫痫。颞叶癫痫（temporal lobe epilepsy,TLE）是一种难治性部分癫痫,虽然不断有新型抗癫痫药物出现,但是研究表明它们对颞叶内侧癫痫的完全缓解效果不佳,因此该病常常需要手术治疗。     

MR评估颞叶癫痫治疗效果研究进展

颞叶癫痫（TLE）是临床最常见的癫痫类型,一般可予以药物治疗;当发展为难治性癫痫时,需考虑手术治疗。目前主要通过观察治疗后一定时期内癫痫发作的频率来评估治疗效果,无法实现实时、客观评价。随着MRI技术及图像分析方法的不断进步,多模态MRI已广泛应用于评估TLE治疗效果。本文就多模态MRI及其技术评估TLE患者癫痫缓解情况及认知功能的研究进展进行综述。     

颞叶新皮质癫痫的手术方式探讨

目的分析总结颞叶新皮质癫痫患者临床特征、术前评估、手术方法和疗效。方法对6例颞叶新皮质癫痫患者（经术中皮层电极和深部电极描记证实），回顾性研究其术前临床表现特点、电生理学、影像学（MRI、SPECT）定位、术中皮层电极和深部电极描记、手术方式（标准前颞叶切除＋致痈灶皮质热灼术＋杏仁核海马部分切除术）以及随访6个月-2年的疗效观察。结果6例颞叶外侧癫痫术后疗效，根据谭启富等学者的标准分类：Ⅰ级3例，Ⅱ级1例，Ⅲ级1例，Ⅳ级1例。Ⅴ级0例。病理报告：胶质增生4例；微小血管畸形1例；无异常发现1例。术后并发症：1例近记忆功能障碍，1例不全性感觉失语，1例对侧上象限盲；无手术致残和死亡。结论术前根据临床表现特点、电生理学、影像学和SPECT准确定位，术中根据ECoG及深部电极发现，联合采取不同术式（强调常规均行海马杏仁核部分切除术）彻底切除痫灶，对颞叶新皮质癫痫可达到良好的治疗效果，且无严重手术并发症。     

术中磁共振导航辅助显微外科手术治疗颞叶内侧型癫痫

目的 探讨术中磁共振影像神经导航系统在辅助显微外科手术治疗颞叶内侧型癫痫的应用价值. 方法 对26例诊断明确的难治性颞叶内侧型癫痫患者,采用术中磁共振影像实时神经导航辅助,结合术中脑电图监测,行显微外科手术切除前内侧颞叶、海马及杏仁核. 结果 26例患者术后复查核磁均显示前内侧颞叶切除满意,病理证实内侧结构萎缩或硬化;本组患者随访12个月以上,癫痫发作完全消失者(Engel Ⅰ级)23例(88.5％),癫痫发作极少者(EngelⅡ级)2例(7.7％),癫痫发作有手术价值的减少者(EngelⅢ级)1例(3.8％).患者均未出现严重的手术并发症,神经功能保持良好. 结论 术中磁共振导航辅助显微外科手术治疗颞叶内侧型癫痫,既能彻底切除致痫灶,又能有效地保留神经功能,提高了手术的准确性与安全性.     

Temporal disconnection as an alternative treatment for intractable temporal lobe epilepsy: techniques, complications and results

Temporal lobe epilepsy (TLE) is the most common form of intractable partial epilepsy in adults. Surgery (lobectomy or amygdalohippocampectomy) is effective in most patients. However, some complications can occur and brain shift, hematoma into the post operative cavity and occulomotor nerve palsy have been reported due to the surgical technic. We report the technique, safety and efficacy of temporal disconnection in nonlesional TLE. Forty-seven patients (18 males, 29 females; handedness: 12 left, 33 right; aged 35 years ± 10; mean duration of epilepsy: 24 ± 10 years) underwent temporal disconnection (20 left, 27 right) guided by neuronavigation. Sixteen patients (35 %) underwent additional presurgical evaluation with SEEG. The outcome was assessed using Engel's classification. At the two-year follow-up, 85 % of the patients were seizure-free (Engel I), 26 (58 %) of whom were Ia. Postoperative persistent morbidity included mild hemiparesis (n = 1), mild facial paresis (n = 1), quadranopsia (n = 23) and hemianopia (n = 1). Verbal memory worsened in 13 % of cases when the disconnection was performed in the dominant lobe. MRI follow-up showed two cases of nonsymptomatic thalamic or pallidal limited ischemias, two cases of temporal horn-cystic dilatation, one requiring surgical reintervention without sequelae. There was one case of postoperative phlebitis. In the seizure-free patient group, postoperative EEG showed interictal temporal spikes at three months, one year and two years located in the anterior temporal region. Temporal disconnection is effective, prevents the occurrence of subdural cyst and hematomas in the temporal cavity, prevents the occurrence of oculomotor palsy, and limits the occurrence of quadranopsia. However, comparative studies are required to evaluate temporal disconnection as an alternative to lobectomy in nonlesional TLE.     

Epilepsy surgery for drug-resistant temporal lobe epilepsy in over-50 year-olds: Seizure outcome,surgical complications and neuropsychological outcome

ObjectiveSurgery is an effective treatment for drug-resistant temporal-lobe epilepsy (TLE), but is still underutilized for older patients because of a perceived higher rate of perioperative complications, cognitive decline and worse seizure outcome.MethodsWe retrospectively screened all patients operated on in our institution for drug-resistant TLE between 2007 and 2019. Data of patients aged ≥ 50 years versus < 50 years at surgery were compared. The primary endpoint was freedom from disabling seizure (Engel I) at 2 years postoperatively.ResultsIn patients aged ≥ 50 years (n = 19), mean age at surgery was 54.9 years and mean disease duration was 36.6 years. At 2 years postoperatively, rates of Engel I seizure outcome were not significantly different between the two groups (73.9% in the < 50 years group versus 94.4% in the ≥ 50 years group). Although surgical complications were significantly (47.4%) in the older patients, neurological deficit was permanent in only 5.3% of cases. At 1 year postoperatively, neuropsychological outcome did not significantly differ between the two groups.ConclusionsPatients aged ≥50 years had an excellent seizure outcome at 2 years postoperatively. Early postoperative complications were more frequent in patients aged ≥50 years but were mostly transient. Cognitive outcome was similar to that in younger patients. These findings strongly suggest that age ≥50 years should not be an exclusion criterion for resective epilepsy surgery in patients with drug-resistant TLE.     

Outcome of adult patients with temporal lobe tumours and medically refractory focal epilepsy

Summary   Background. Tumours are a well-recognized cause of medically intractable epilepsies. Tumours represent the primary pathology in 10%–30% of patients undergoing surgical treatment for chronic epilepsy. This study examines the surgical and epileptological outcome of adults with temporal lobe tumoural epilepsy treated within a comprehensive epilepsy surgery programme. Methods. Between 1999 and 2004, 99 consecutive patients have been operated for intractable temporal lobe epilepsy (TLE). Among these, 14 adult patients exhibited temporal lobe neoplasms associated with TLE. Every patient underwent a comprehensive presurgical evaluation including video-EEG monitoring, MRI, interictal PET scan, ictal SPECT and neuropsychological testing. Surgical strategies were determined in an interdisciplinary seizure conference and tailored to the findings of the presurgical evaluation. All patients were available for follow up at regular intervals after 3, 6, 12 months and yearly thereafter. Epileptological outcome was classified according to Engel [10] and the ILAE (International League Against Epilepsy)/systems [33]. Findings. The surgical procedures performed were temporal lobe resection in 3 patients, extended lesionectomy in 4 and extended lesionectomy with resection of the temporomesial structures in 7. One patient with an astrocytoma grade III underwent a second and third operation for recurrent disease. Histological results: Astrocytoma 5 patients, ganglioglioma/gangliocytoma 5, oligodendroglioma 2, ependymoma 1 and dysembryoplastic neuroepithelial tumour (DNET) 1. Postoperative follow-up was performed after 12–74 months (mean 31). The outcome according to the Engel classification indicated class IA in 9 patients, class IC in 3, and 1 each in classes IIIA and IVA. Epileptological outcome according to the ILAE classification indicated class 1 (12 patients) and class 4 (2 patients). Surgical mortality was zero and mild permanent neurological deficits due to surgery were seen in 2 patients. Postoperatively 3 patients showed a homonymous quadrantanopia. Conclusions. Patients with drug resistant epilepsy and temporal lobe tumours should undergo evaluation in dedicated epilepsy surgery programmes.     

Frontal lobe epilepsy: diagnosis and surgical treatment

Frontal lobe epilepsy has been better understood during the past two decades with the advent of technologies with improved localizing capabilities. Major technological advances in the ability to delineate structural and functional brain regions have led to a resurgence of interest in epilepsy surgery. Neuroimaging modalities have broadened the scope of what are now considered surgically remediable syndromes. In the following article, we attempt to review the current concepts regarding diagnosis and surgical management of frontal lobe epilepsy. Electronic Publication     

难治性颞叶癫癎的显微外科治疗

目的　总结显微外科手术治疗难治性颞叶癫的临床经验。　方法　回顾性分析显微外科手术切除前颞叶 5 0例颞叶癫的病例。　结果　无死亡病例。术后随访半年至 5年 ,症状发作完全消失 2 5例 ,基本消失 13例 ,发作次数减少 5 0 %或变型小发作 9例 ,无效 3例 ,有效率达 95 %。　结论　应用显微外科技术切除前颞叶治疗颞叶癫可以明显减少并发症 ,提高临床疗效。     

Predictors of verbal memory decline following temporal lobe surgery

BACKGROUND AND PURPOSE: Verbal memory decline can occur after temporal lobe surgery, especially when the left dominant hemisphere is involved. This potential functional risk must be evaluated before surgery. Among all factors that have been identified by several studies, the side of surgery (left dominant) and high baseline memory performance have been found to be predictive of verbal memory decline. Other factors such as etiology, sex, age at surgery, age at seizure onset, and duration may influence memory decline, but the results are not clear. Our purpose was to identify, in our population of patients and among all risk factors, those that may be predictive of verbal memory decline. METHODS: Logistic regression was used to examine the effect of each factor on the postoperative verbal memory index (WMS-R) in 101 patients who underwent a right (n=49) or left (n=52) anterior temporal lobe resection. RESULTS: In the group as a whole, 22 % of the patients demonstrated verbal memory decline of more than one standard deviation. The verbal memory decline was significantly related to surgery on the left side and a high level of verbal memory performance. These factors were significant predictors of decline. The other factors (etiology, sex, age at surgery, age at seizure onset, and duration) were not found to be predictive of this decline. CONCLUSIONS: Our analysis demonstrates that the patients who are most at risk of undergoing verbal memory deterioration are those who undergo left-sided temporal resection and have good memory scores preoperatively. The contradictions found in the literature about the other factors could be explained by the diversity of the tests and criteria used to assess memory decline.