立体定向毁损和软膜下横切术联合治疗双侧颞叶癫痫12例

目的 探讨双侧颞叶癫痫（BTLE）立体定向毁损和软膜下横切术联合治疗的方法。方法12例顽固性癫痫患者,经临床症状、长程视频脑电监测（V-EEG）、头颅CT、MRI、磁共振波谱（MRS）、正电子发射断层显像-计算机断层显像（PET-CT）、脑磁图（MEG）、神经心理学和术中皮层脑电（ECoG）以及深部脑电（DEEG）检查,发现在双侧颞叶存在着各自独立的致痫灶,诊断为BTLE。针对一侧杏仁核海马复合体及一侧和／或双侧颞叶新皮层中的致痫灶,分别给予立体定向杏仁核海马毁损（SAHT）和多处软膜下横切术（MST）联合治疗。结果随访6-32个月,按照Engel的疗效判断标准：I级5例,Ⅱ级3例,Ⅲ级3例,Ⅳ级1例。术后未发生永久性并发症。结论采用立体定向毁损和软膜下横切术联合治疗BTLE是安全有效的。

Combination of stereotactic lesion and multiple subpial transsection in treatment of bitemporal lobe epilepsy: report of 12 cases

OBJECTIVE: To explore the effect of combination of stereotactic lesion and multiple subpial transsection (MST) in treatment of bitemporal lobe epilepsy (BTLE). METHODS: Independent epileptogenic foci were found in bilateral temporal lobes by video-electroencephalogram, computed tomogrphy, magnetic resonance imaging, magnetic resonance spectroscopy, positron emission tomography-computed tomography, magnetoencephalography, neuropsychology and intraoperative electrocoticography, and depth EEG in 12 patients with intractable epilepsy. Then the BTLE patients were treated with stereotactic amygdalohippocampotomy (SAHT) and MST respectively according to the sites of the. epileptogenic foci: in the amygdalohippocampus complex or temporal neocortex. Followed-up was conducted for 6 - 32 months. RESULTS: The curative effects of the 12 patients according to Engel's standard were grade I in 5 cases, grade II in 3 case, grade III in 3 cases, and grade IV in 1 case. No permanent complication was found. CONCLUSION: Combination of SAHT and MST procedures is safe and effective in treatment of bitemporal lobe epilepsy.