难治性颞叶癫痫的外科治疗(附35例临床分析)

目的总结并分析难治性颞叶癫痫患者术前定位、手术方式和经验。方法回顾性分析2009年6月至2011年6月,采用颞前叶+海马杏仁核切除术治疗的颞叶癫痫病人35例,其中术前MRI及术后病理证实伴有海马硬化者32例,所有病例术中均在皮层电极监测下切除颞叶皮质及同侧海马、杏仁核,手术后均应用抗癫痫药物治疗,术后随访1～3年。结果在35随访病例中,癫痫发作控制结果显示EngelⅠ级24例,Ⅱ级8例,Ⅲ级3例,Ⅳ级0例。其中有12例病人术后2年逐渐停用抗癫痫药物。结论联合应用VEEG、MRI及EcoG能准确确定致痫灶,提高颞叶癫痫手术疗效。手术方式选择及显微理念的应用,能有效减少术后并发症的发生,避免出现永久性神经功能缺失。

Surgical treatment of intractable temporal lobe epilepsy(a report of 35 cases)

Objective To summarize and analyze the preoperative localization,surgical approach and experience in patients with refractory temporal lobe epilepsy.Methods Of a series of 35 cases with intractable TLE,who were treated temporal anterior lobe + hippocampus amygdala resection during the period from June 2009 to June 2011.32 cases confirmed hippocampal sclerosis with preoperative MRI and postoperative pathology.All patients were resected the temporal cortex and hippocampus,amygdala in ECoG.Antiepileptic drug treatment after surgery,patients were followed up for 1-3 years.Results The seizure outcome according to Engel outcome scale were Ⅰgrade in 24 cases,II in 8,III in 3,0 in IV.12 patients,the phasing out of antiepileptic drugs after 2 years.Conclusion The combination VEEG,MRI and EcoG can accurately determine the epileptogenic zone,improve the surgical treatment of temporal lobe epilepsy.Surgical approach and the application of microstructure concept,can effectively reduce the incidence of postoperative complications,to avoid permanent neurological deficits.