磁共振波谱结合长程视频脑电图在颞叶癫痫手术中的临床应用

Clinical application of MRS combined with long-term VEEG on the surgical treatment of temporal lobe epilepsy

目的 探讨磁共振波谱(MRS)结合长程视频脑电图(VEEG)在颞叶癫痫手术中的应用价值.方法 收集2009年7月-2012年12月于武汉脑科医院采用MRS和VEEG行定位诊断,并行前颞叶切除的51例患者资料,其中男31例,女20例;年龄4 ~62岁.病程4~10年.临床表现为复杂部分性发作10例,部分性继发全身性发作12例,全身强直-阵挛性发作29例.MRS检查提示左侧海马硬化26例,右侧海马硬化25例.VEEG监测提示左颞异常放电26例,右颞异常放电25例.结合患者的临床表现、MRS和VEEG监测结果,对所有患者行前颞叶切除术(包括大部分海马和杏仁核).结果 51例的术后均获得门诊随访,随访时间1~3年,随访发现36例癫痫发作完全消失(Engle Ⅰ级),11例术后较术前显著改善(EngleⅡ级),4例效果不佳(EngleⅣ级),手术总有效率92.16%.结论 MRS结合VEEG对颞叶癫痫有明显的定位诊断价值,对诊断明确的颞叶癫痫患者行前颞叶切除术,术后疗效较满意.

Objective To explore the application value of MRS combined with VEEG on the surgical treatment of temporal lobe epilepsy.Methods There were 31 males and 20 females,age between 4 and 62 year.Their ilness duration ranged from 4 to 10 years.The clinical manifestations showed complex parial seizure in 10 cases,secondary generalized seizure in 12 and generalized tonic-clonic seizure in 29.Based on their results of eclinical manifestations,MRS and VEEG results,all the patients underwent anterior temporal lobectomy(including the most parts of the hippocampus and amydala).Results The fllow-up of 1~3 years after the operation showed seizure free in 36 cases(Engle I),and significant improvement in 11(Engle I),no improvement in 4 cases(Engle IV).The overall efetive rate was 92.16%,Conclusions MRS combined with VEEG has significant localization value for temporal lobe epilepsy.The prognosis of postoperative result is quiet good to the paticnt of typical temporal lobe epilepsy after anterior temporal lobectomy.