颞叶癫痫伽玛刀治疗效果评判时限

Time for Judging Curative Effect of Gamma Knife Surgery on Refractory Temporal Lobe Epilepsy

目的总结分析颞叶癫痫伽玛刀治疗效果以及效果趋于稳定的时限。方法对74例颞叶癫痫患者伽玛刀术后行长期随访,并依照Engel标准对患者术后效果进行分级;比较患者术后一年、两年、三年和远期(三年半以上)疗效,观察术后达到EngelⅠ-Ⅱ级疗效比例的变化。结果74例患者伽玛刀术后达到EngelⅠ-Ⅱ级预后的比例随时间延长有明显差异。一年和二年随访时预后达到EngelⅠ-Ⅱ级的患者比例与术后三年和远期(3￣10年,平均5.8年)随访时有明显差异(P<0.05)。但术后一年与二年时以及三年与三年以上时,预后达到EngelⅠ-Ⅱ的患者比例无明显差异(P>0.05),术后3￣10年的总有效率为65.8%(48/73)。结论颞叶癫痫伽玛刀治疗安全有效,且损伤轻,并发症少。术后两年期内的随访评判疗效不可靠,而三年期随访疗效高度预示术后长期效果。

Objective To analyze the curative effect of gamma knife surgery on refractory temporal lobe epilepsy, and the critical time for judging it. Methods The long-term following up was performed in 74 consecutive adult patients with refractory temporai lobe epilepsy who underwent gamma knife surgery. According to Engel standard of the curative effect, the patients were classified. The curative effects 1, 2, 3 and 3-10 years （mean, 5.8 years） after gamma knife surgery were compared to each other. Results The ratio of the patients with Engel grades Ⅰ - Ⅱ outcomes to all the patients was different along with the time after gamma knife surgery. There was insignificant difference in the ratio of the patients with Engel grades Ⅰ - Ⅱ outcomes to all the patients between 1 year and 2 years and between 3 years and 3-10 years after gamma knife surgery. The ratioes of the patients with Engel grades Ⅰ -Ⅱ outcomes to all the patients 3 years and 3-10 years after the gamma knife surgery were significantly higher than those 1 year and 2 years after the gamma knife surgery （P〈0.05）. The total effective rate was 65.8% （48/73, 1 patients died from a traffic accident during following up） 3-10 years after the gamma knife surgery. Conclusions Gamma knife surgery for refractory temporal lobe epilepsy is safe and reliable, and its curative effect is good. The curative effect of gamma knife surgery on the refractory temporal lobe epilepsy is unstable within 2 years after the gamma knife surgery. The curative effect 3 years after the gamma knife surgery is stable and may predict the long-term outcome.