双侧颞叶癫痫患者立体定向脑电图的定侧价值及手术疗效

Application of stereotactic electroencephalography in patients with bilateral temporal lobe epilepsy indicated by scalp electroencephalography

目的探讨立体定向脑电图在双侧颞叶癫痫患者中的定侧价值及手术疗效。方法回顾性分析2017年1月至2018年12月北京航空总医院神经外六科收治的12例经头皮脑电图提示双侧颞叶癫痫患者的临床特征,对其进行双侧颞叶立体定向脑电图监测。根据监测结果,对单侧颞叶癫痫患者进行单侧颞叶+海马杏仁核切除术;对双侧独立起源、双侧颞叶间起源有明显差别的患者行主要侧前颞叶+海马杏仁核切除术。对于双侧无明显区别的双侧颞叶癫痫,根据MRI行有海马萎缩或硬化侧前颞叶+海马杏仁核切除术,若MRI阴性或双侧无明显差别,则根据FDG/PET行代谢更低侧前颞叶+海马杏仁核切除术。结果立体定向脑电图监测发现,12例患者中3例为单侧颞叶发作起源,9例为双侧颞叶独立发作起源,均行主要侧前颞叶+海马杏仁核切除术。术后3例疗效达到Engle分级Ⅰ级,2例Engle分级Ⅱ级,5例为Engle分级Ⅲ级,2例为Engle分级Ⅳ级。结论头皮脑电图提示双侧颞叶癫痫中一部分为单侧颞叶起源,前颞叶+海马杏仁核切除术可达到较好的疗效;立体定向脑电图是双侧颞叶癫痫术前评估侧别非常重要的方法。对于双侧独立起源的颞叶癫痫,切除主要侧颞叶有一定疗效。

Objective To investigate the value of stereo-electroencephalography(SEEG)in bilateral temporal lobe epilepsy and the effect of operation.Methods A retrospective analysis was conducted on the clinical characteristics of 12 scalp eeg patients with bilateral temporal lobe epilepsy admitted to the sixth department of neurosurgery of Beijing aviation general hospital from January 2017 to December 2018,and bilateral temporal lobe stereodirectional eeg monitoring was conducted on them.According to the monitoring results,unilateral temporal lobe+amygdala resection was performed in patients with unilateral temporal lobe epilepsy.Patients with bilateral independent origin and bilateral intertemporal lobe origin with significant differences were treated with primary lateral anterior temporal lobe+hippocampal amygdala resection.For bilateral temporal lobe epilepsy with no significant difference between the two sides,MRI was performed to remove anterior temporal lobe with atrophy or sclerosis of the hippocampus plus amygdala.If MRI was negative or there was no significant difference between the two sides,FDG/PET was performed to remove anterior temporal lobe with lower metabolism plus amygdala.Results Stereo-electroencephalography(SEEG)monitoring showed that 3 of the 12 patients had unilateral temporal lobe onset origin,and 9 patients had bilateral temporal lobe independent onset origin,and all patients had major lateral anterior temporal lobe+hippocampal amygdalectomy.3 cases of postoperative curative effect to Engle classⅠ,2 cases of Engle classⅡ,5 cases of Engle classⅢ,2 cases of Engle classⅤ.Conclusion Scalp electroencephalogram(eeg)indicated that partial temporal lobe epilepsy was unilateral temporal lobe with anterior temporal lobe and amygdala resection.Stereo-electroencephalography(SEEG)is an important method for preoperative evaluation of bilateral temporal lobe epilepsy.For bilateral temporal lobe epilepsy of independent origin,the removal of the main temporal lobe has a certain effect.