颞叶的局部解剖与癫痫的手术治疗（颞叶切除术的一些改进）

目的:复习颞叶的局部解剖,探讨颞叶切除方法的改进。方法:(1)手术技巧的改进:①首先寻找侧脑室颞角;②经颞上回切除颞叶外侧皮质;③在直视下切除颞叶内侧结构(杏仁核、海马、勾回及海马旁回等)。(2)在ECoG监测下,反复描记ECoG,尽可能切除致痫组织。结果:结果满意者38％,显著改善者占40％,良好者占10％,效差6％,无改善者6％。并发症:偏瘫加重1例,无菌性脑膜炎3例,记忆力下降4例,无手术死亡。结论:熟悉颞叶解剖应用改进的颞叶切除法,术后的并发症少,控制癫痫效果好。

Anatomy of the temporal lobe and surgery of epilepsy.(A modified techniques for temporal lobectomy)

Objective: To review anatomy of the temporal lobe and study modified technique of temporal lobectomy. Method: The pro-cedure is carried out in three steps: (1)Transcortical(T2 - Middlegyrus) approach to the temporal horn of the lateral ventricle. (2)The resection of anterior temporal lateral cortical is performed along the first temporal gyrus to the fusiform gyms. (3)Medial temporal lobe siructures of resection which include amygdala, hippocampus, uncal gyrus and parahippocampus is done, ECoG ( Electrocorticography) is used to delineate the epileptic areas and to evaluate the amount ot residual activity in view of further resection. Results: (1)Satisfactory outcome in 38. 2% , (2)Marked improvement in 39.6% , (3) Improvement in 10% , (4) Slight improvement and no improvement in 12% . Complications of surgery including hemiplegia in 1 case, aseptic meningitis in 3 cases, and memory deficits in 3 cases. Con-clusion:The authors feel that anatomy of temporal lobe should be identified accurately and modified anterior temporal lobectomy be used. Postoperative complications were reduced and seizure s control was considered favorable