双侧颞叶海马病变致药物难治性癫的外科治疗

目的探讨双侧颞叶海马病变致药物难治性癫的外科手术治疗方法及效果。方法 5例MRI显示双侧颞叶病变的患者,临床症状、核磁共振成像（MRI）、长程视频脑电监测（V-EEG）及正电子发射断层显像-计算机断层显像（PET-CT）等检查均不能定位起源病灶,行MRI引导立体定向下双侧海马深部电极置入术,对术后V-EEG,综合分析结果,确定起源病灶侧别后行手术治疗。结果术后随访半年以上,按照Engel的疗效判断标准：Ⅰ级4例（行起源侧前颞叶海马杏仁核切除术）,Ⅱ级1例（行起源侧海马神经调控治疗）。结论对双侧颞叶海马病变致药物难治性癫,通过立体定向下双侧海马深部电极置入术及术后长程V-EEG方法,综合分析结果能较准确确定癫起源灶,同时也能成功指导外科手术。

Surgical Treatment of Medically Intractable Bilateral Temporal Lobe Epilepsy

Objective To explore the surgical treatment of medically intractable bilateral temporal lobe epilepsy.MethodsThe onset zone of epileptogenic focus could not been found exactly by clinical symptoms,magnetic resonance imaging（MRI）,video-electroencephalogram（V-EEG） and positron emission tomography-computed tomography（PET-CT）in 5 patients with bilateral temporal lobe epilepsy.Bilateral hippocampal depth electrodes were inserted stereotaxically with MRI guidance and postoperative V-EEG was preformed to record epileptic activity.After comprehensive analysis and judgment,the onset zone of epileptogenic focus was located and then the surgical ablation or neuromodulation was performed in these patients.ResultsPatients were followed-up for at least 6 months.According to Engel＇s standard,the curative effects were grade I in 4 patients（surgical ablation） and grade Ⅱ in 1（neuromodulation）.ConclusionThe onset zone of epileptogenic focus can be located accurately after stereotactic implantation of bilateral hippocampal depth electrodes and comprehensive analysis and judgment of postoperative V-EEG.The method is effective in surgical treatment of medically intractable bilateral temporal lobe epilepsy.