立体定向引导选择性海马切除治疗颞叶内侧癫痫(附11例临床报道)

Stereotactic guided selective hippocampus resection to treatment mesial temporal epilepsy

目的探讨应用立体定向引导微创手术选择性海马切除治疗颞叶内侧癫痫的方法的可行性.方法11例内侧颞叶癫痫病例,根据EEG、MRI、PET-CT等资料,初步确定癫痫灶位于一侧海马,然后在立体定向引导下置深部电极于海马,确认癫痫灶位于海马后即以深部电极为手术导向标志在显微镜下作选择性海马切除术.结果随访1～2年疗效满意8例(72.7%),显著改善2例(18.2%),良好1例(9.1%).术后无其他神经系统并发症,无死亡病例.结论综合应用影像学、核素检查,海马深部电极植入记录海马脑电,对内侧颞叶癫痫灶定位可以明确诊断;癫痫病灶的起源精确定位于海马后,在立体定向引导下作单纯选择性海马切除治疗颞叶内侧癫痫可获得满意疗效.

Objective To study the methods of stereotactic guided selective hippocampus resection to treatment mesial temporal epilesy. Methods By the application of imaging examination,EEG, electrocorticogram, PET-CT techniques, the epilepsy focus was precisely located in monolateral temporal lobe,11 patients with refractory epilepsy were treated surgically guided by stereotatic techniques. Results The 1-2 years following-up outcomes showed that the satisfaction were 8 cases （72.7%）, significant improvements were 2 cases （18.2 % ）, good was 1 cases （9.1% ）. There were no serious complications and no death. Conclusion Combined use of CT, MR,PET and the deep brain electrode EEG can comfirm the EP focus in one side of hippocampus in some cases of MTLE. Furthermore, miniinvasive hippocapolotomy and amigdolotomy under guide of stereotactic tecnic may benefit for this patients.