小儿难治性颞叶癫痫的外科治疗(附78例报告)

Surgical Treatment of Intractable Temporal Lobe Epilepsy in Childhood:an Analysis of 78 Cases

【目的】研究小儿难治性颞叶癫痫的致痫灶定位、手术适应证及手术治疗效果。【方法】综合运用脑电图、影像学、偶极子定位与颅内电极等方法，对78例难治性颞叶癫痫患儿进行癫痫灶定位和外科手术治疗，并进行手术疗效和手术前后心理状况评估。【结果】所有患儿术后均定期随访6～28个月，疗效满意45例（57．7％），显著改善19例（24．4％），良好11例（14．1％），效果差2例（2．5％），无改善1例（1．3％）。原有智力缺陷改善13例，占36．1％（13／36），行为障碍恢复23例，占41．5％（23／53），学习困难提高18例，占72．0％（18／25）。心理状况改善16例，占53．3％（16／30），无变化8例，占10．2％（8／78）。【结论】综合应用影像学、电生理和计算机图像融合技术，可以对大多数颞叶癫痫病灶的起源进行精确定位诊断，早期外科手术对小儿难治性颞叶癫痫是一种有效治疗方式。

[Objective] To study the methods of exact localization of epilepsy focus and the indication and efficacy of surgical treatment for intractable temporal lobe epilepsy in childhood. [Methods] From 2005 to 2006, seventy eight children with intractable temporal lobe epilepsy undergoing anterior temporal lobe resection, hippocampus resection and amygdaloidal nucleus resection accordingly were assessed with EEG, CT, MRI,PET-CT, image fusion techniques and psychometric studies. [Results] All patients were followed up for 6 to 28 months. Surgical results were satisfactory in 45 patients （57.7 % ）, improved in 19 （24.4 % ）, fine in 11 （14.1%） ,bad in 2 （2.5%） and ineffective in 1 （1.3%）. The total effective rate was 96.2%. Preexisting mental deficiencies were ameliorated in 13 （36.1 % ）, behavioral disturbances were rehabilitated in 23 （41.5 % ）, and the ability of learning was improved in 18 （72.0 % ）. [Conclusion]The development of imaging procedures, electrophysiology and computer fusion techniques has simplified precise localization of seizure. Furthermone, early surgical intervention is a safe and effective treatment for intractable temporal lobe epilepsy in childhood.