颞叶癫痫的显微外科手术治疗(附26例分析)

目的探讨颞叶癫痫的术前评估的手术治疗。方法对26例颞叶癫痫患者行无创或有创检查,进行术前综合评估,采用额颞翼点切口,经外侧裂入路、皮质脑电图监测下实施手术。对术前评估方法,术中脑电图监测及手术方式进行分析。结果20例患者根据24h发作期视频脑电图监测结果和磁共振成像、PET-CT等检查进行致痫灶的定位,16例术前置入颅内电极明确致痫灶的位置,术后随访6个月至2年,20例癫痫发作基本消失(85%),3例发作基本减少(70%),2例发作减少>50%,其中4例出现短期并发症。术后2年所有手术患者日常生活能力平分与手术前相比明显改善(P<0.05)。结论长程视频脑电图(发作期)和磁共振成像、PET-CT发作期/发作间期检查是颞叶癫痫致痫灶定位的可靠手段,颅内电极置入是术前准确定位的必要手段,外侧裂入路可以满足颞前叶切除或选择性切除颞叶内侧结构的良好术式。

Microsurgical Treatment for Temporal Lobe Epilepsy

Objective To explore the preoperative evaluation and operative strategies in patients with temporal lobe epilepsy.Methods Twenty-six patients with temporal lobe epilepsy underwent noninvasive or invasive preoperative evaluation.Transsylvian approaches were performed with the24-hour intracranial EEG monitoring.The approaches of resection and the methods of preoperative evaluation were analyzed.The clinical outcomes were categorized and the quality of life of patients were evaluated based on the activity of daily living scale at different periods during the two-year follow-up.Results Among the total 26 patients,epileptogenic zones were localized with noninvasive techniques of long-term video-EEG recording MRI,and PET-CT in 20 patients,and with intracranial electrodes in 16 patients.These patients were followed up for 6-24 months postoperatively.20(85%)patients were free from seizure,the seizure frequency was reduced by 70%in 3 patients,and reduced by 50%in 4 patients.Four patients who had temporary complications recovered in three months.There were significant differences(P<0.05)between the postoperative and preoperative activity of daily living scales.Conclusion Long-term 24-hour video-EEG(episode period),and MRI/PET-CT(episode /interictal period)were the reliable noninvasive preoperative methods for localizing epileptogenic zone.Electrocorticogram was useful to guide the resection.The transsylvian approach was safe and effective for anterior temporal lobectomy and selective amygdalo-hippocampectomy.