立体定向热凝毁损海马杏仁核治疗海马病变所致难治性颞叶内侧癫

Stereotactic amygdalohippocampotomy for treatment of medial temporal lobe epilepsy caused by hippocampus lesions

目的探讨立体定向手术热凝毁损海马杏仁核治疗海马病变所致难治性颞叶内侧癫的疗效。方法回顾分析19例由海马病变所致难治性颞叶内侧癫患者的临床表现、影像学(CT/MRI)脑电图(EEG/VEEG)资料和手术疗效。所有病例术前均行动态脑电图检查明确致灶完成定位诊断、术中行立体定向组织活检、快速冰冻病理确诊病变性质完成定性诊断。全部患者在计算机辅助下行致灶侧海马杏仁核立体定向热凝毁损术。手术效果按谭启富的评定标准进行评价。结果随访12～42个月,13例癫未再发作(满意),4例发作次数减少75%以上(明显改善),2例发作次数减少50%(改善)。未发现神经心理学改变及神经功能障碍等并发症。结论对于由海马病变所致难治性颞叶内侧癫,采用立体定向手术行海马杏仁核热凝毁损是控制癫发作的一种安全有效方法。

Objective To explore the therapeutic effect of stereotactic for intractable medial temporal lobe epilepsy caused by the pathologic amygdalohippocampotomy change of hippocampus. Methods Retrospective analysis the clinical manifestations, imaging （ CT/MRI ）, electroencephalogram （EEG/VEEG） information and surgical effect of 19 cases of refractory MTLE caused by hippocampus lesions. The dynamic EEG examiautis were performed in all cases for localization of epileptic foci before operation, and the stereotactic biopsy, fast frozen pathological examination were performed for qualitative diagnosis before coagulation. Afterwards the stereotactic amygdalohippocampotomy at the side of epileptic foci weve pevforwed in all patients under the EEG monitoning assistance. The surgical efficacy of epilepsy was assessted according to the standards of Tan Qi-fu. Results Followed-up 12 to 42 months, epilepsy manifest disappeared in 13 cases （satisfaction）, seizure frequency reduced more than 75% in four cases （distinct improvement） and reduced by 50% in two cases （improvement）. There was no change in neuropsychological and neurological dysfunction, and other complications. Conclusions For the intractable medial temporal lobe epilepsy caused by hippocampus lesions, the use of stereotactic amygdalohippocampotomy to control of seizures is a safe and effective method.