手术治疗顽固性颞叶癫痫(附23例报告)

目的探讨颞叶癫痫手术适应证与术式选择。方法根据发作类型和表现、发作间期EEG及头颅MRI扫描，选择顽固性颞叶癫痫综合征23例进行手术治疗，其中单侧海马硬化16例。行前颞叶切除术7例，经颞中回侧脑室入路与经侧裂侧脑室入路选择性杏仁核海马切除术分别4、5例；蛛网膜囊肿2例仅行囊肿壁切除术；颞中回后部胶质瘤1例先行病灶切除术，术后因癫痫仍发作于术后第5天再次行前颞叶切除术；颞叶内侧肿瘤4例行肿瘤切除术加前颞叶切除术。术后随访3～22月。结果16例海马硬化中，2例术后1周内分别出现1次和2次强直阵挛发作．服卡马西平后未再发作，3例术后6～8个月的随访期内共发作1、3、3次，余11例未发作。蛛网膜囊肿者术后发作次数减少90％，颞叶肿瘤除1例术后第6天出现强直阵挛发作1次外未出现发作。结论在筛选颞叶癫痫手术适应证时，应注意癫痫发作形式和MRI表现，根椐病因选择术式。

Surgical treatment of intractable temporal lobe epllepsy(23 cases reported)

Objective To explore indications of temporal lobe epileptic syndrome for surgery and strategy for choosing surgical modesMethods 23 patients with intractable temporal lobe epilepsy were screened out and treated surgically according to seizure types,interictal scalp EEG and cranial MRI16 were of hippocampal sclerosis cases,among which,anterior temporal resection including hippocampus and amygdala was conducted in 4 cases,selective amygdalohippocampectomy through the second temporal gyrus in 4 cases,and selective amygdalohippocampectomy through sylvian fissure in 5 casesCysticectomy was conducted in the 2 cases of arachnoid cystLesionectomy plus anterior temporal lobectomy was carried out in the 5 cases of neoplasmAll patients have been followed up for 3~22 months postoperativelyResults Among the 16 patients with hippocampal sclerosis,11 cases had no seizures after surgeryThe 2 patients with temporal arachnoid cyst had reduction of seizures by 90% after surgeryPatients with neoplasm were seizure free except one who had one tonic-clonic seizure after surgeryConclusions In screening patients with temporal lobe epilepsy for surgery,seizure pattern and MRI is very importantSurgical mode can be modified according to pathology