145例颞叶癫痫手术治疗及两年以上随访

目的：总结145例颞叶癫痫（TLE）的术前评估、手术方式和两年以上的随访结果。方法：对145例TLE患者的术前评估方法、手术方式、病理结果和手术效果进行了回顾性分析。结果：在145例TLE患者中，111例（76．6％）患者根据长程V—EEG和MRI等无创检查定位了致痫灶，34例（23．4％）需应用颅内电极记录定位。前颞叶切除或扩大前颞叶切除127例（87．6％），合并颞叶以外切除16例（11％）；术后病理改变最常见的是海马硬化和皮质发育不良。随访（35．6±7．2）个月，Engel术后效果评估为Ⅰ级92例（63．4％，癫痂发作消失），Ⅱ级25例（17．2％，癫痫发作极少或几乎消失），Ⅲ～Ⅳ级26例（17．9％，癫痫发作频率减少〉50％），Ⅴ级2例（1．4％，发作频率减少〈50％）。13例（8．9％）出现并发症，4例（2．7％）为永久性并发症。结论：按照标准的术前评估方法，当评估结果一致定位为一侧颞叶时，可直接行颞叶切除手术；当临床表现是不典型TLE、影像学阴性表现和术前需要准确定位语言区时，颅内埋藏电极和V—EEG长程监测是进行术前评估的必要手段。根据术中皮层脑电监测的结果和病理分析，前颞叶切除是TLE经典的有效的术式。

The surgical treatment and over two years follow up for temporal lobe epilepsy

Objective：To summarize the presurglcal evaluation, the methods of operations ano tne results of over two years follow-up in patients with temporal lobe epilepsy（TLE）. Methods： From 2001 to 2006, 145 patients with TLE underwent noninvasive and invasive presurgical evaluation in our epilepsy center. Different resections were performed based on the results of standardized presurgieat evaluation and intraeranial KEG monitoring. The methods of presurgical evaluation, the styles of resection and the pathological results were analyzed. The clinical outcomes were categorized and assessed according to Engelds classes in different follow-up periods. Results： Epileptogenic zones were localized in all patients by standardized noninvasive presurgical evaluation in lllpatients （76.6%）, by inraeranial electrodes in 34 patients（23.4%）. Hippoeampal sclerosis and malformation of cortical development were the most common two pathologic abnormalities. These patients veceived （35.6±7.2） months follow-up after surgery. Engel＇s Class Ⅰ was found in 92 patients（63.4%, seizure free）, Class Ⅱin 25 patients （ 17.2%, almost no seizure）, others Class Ⅲand Ⅳ in 26 patients （17.9%, the frequency of seizure decreased 75 %）, and Class V in 2 patients （1.4%, the frequency of TLE seizure decreased by〈 50%）; Thirteen patients （8.9%） had temporary complications in three months, and 4 patients （2.7% ） had permanent complications. Conclusion.. The standardized noninvasive presurgical evaluation, if all findings point to the same temporal lobe, temporal lobectomy can be performed directly. Intracraniai electrodes and long-term intracranial EEG are necessery ahen clinical symptoms to be not typical and language area is located before operation. According to electrocorticogram and the analysis of postoperative pathology, anterior temporal lobectomy is safe and effective for temporal lobe epilepsy. Further studies, especially the recognition of postoperative patients require cooperation of multicenter.