颞叶病灶性癫痫的手术治疗

Surgical treatment of lesional temporal lobe epilepsy

目的探讨颞叶病灶性癫痫(lesional temporal lobe epilepsy,LTLE)的术前评估及手术治疗方法。方法回顾性地分析于我研究所接受癫痫手术治疗32例患者的临床资料,MRI 与 CT 检查证实有结构性病灶存在且位于颞叶。根据手术预后将患者分为满意组与非满意组,对两组患者术前病灶特点、电生理情况及术后病理结果等因素进行统计分析。结果 32例 LTLE 患者中24例效果满意,术后满意率为75%,其中病灶为皮层发育障碍的17例,术后满意率为65%;病灶为肿瘤及其他病变的15例,术后满意率为87%。病灶位于标准前颞叶切除术范围之内的共21例,位于此切除范围之外的患者11例,前者的术后满意率高于后者(P<0.05);病灶位于颞叶内侧结构以内的患者8例,以外的患者24例,术后效果差异不显著(P>0.05)。发作间期脑电图异常放电区域局限且位于病灶侧颞叶的患者,满意组中有19例,非满意组中有3例(P<0.05)。结论对于 LTLE 患者,手术治疗应为首选的治疗手段。手术前充分认识病灶的性质、部位以及神经电生理特点,对提高手术满意率有重要意义。

Objective To discuss the presurgical evaluation and surgical treatment of lesional temporal lobe epilepsy（LTLE）. Methods We retrospectively studied the patients whose MRI or CT showed lesions on one of the temporal lobes among patients who underwent epilepsy surgeries in our institute. All patients were divided into satisfactory and unsatisfactory group according to outcomes after operation. The characteristics of the lesions, neurophysiological features and results of pathologies were analyzed statistically. Result Favorable surgical outcome was obtained in 24 patients, the satisfactory rate was 75%. The lesions of 17 patients were cortical malformations and the satisfactory rate of this group was 65%, which was less favorable than that of tumor group, （87%）. 21 patients with their lesions located within the border of standard temporalobectomy, had better surgical outcome than the others whose lesions were beyond the border （ P 〈 0. 05 ）. The satisfactory rate of 8 patients with lesions located within mesial structure of temporal lobe was no differeat compared with that of the others who had lesions outside the mesial structure （ P 〉 0. 05）. There were 19 patients who had consistency of the location of the lesion on MRI with the focal interictal epileptiforrn discharges on scalp EEG in satisfactory group, while there were only 3 patients in unsatisfactory group （ P 〈 0. 05 ）. Conclusion For a LTLE patient, epilepsy surgery should be the first choice to be considered. Careful presurgical studies of the lesion, including its location, pathological property and neurophysiological characteristics, were very helpful for improving the surgical outcome.