68例额叶癫痫的外科治疗与长期疗效随访

Surgery and surgical outcome in sixty-eight patients with frontal lobe Epilepsy

目的总结额叶癫痫的术前评估特征，观察远期手术疗效。方法分析68例额叶癫痫患者的术前评估结果，总结症状学特征、MRI、发作间期SPECT、头皮video-EEG、颅内电极EEG检查的定位价值；应用Engel标准进行术后效果分级，随访2-6年，观察术后的远期疗效。结果不同评估方法可提供准确定位信息的比例分别为：症状学特征38％，MRI40％，发作间期SPECT28％，头皮video·EEG44％，颅内电极EEG81％。最常见的病理改变为皮质发育不良44％（30／68）。EngelI级的60％（41／68），Ⅱ级的12％（8／68），Ⅲ级的10％（7／68），Ⅳ-Ⅴ级的18％（12／68）。癫痫灶定位局限于额叶的病例疗效相对好于同时累及其他脑叶的病例（P〈0．05）。出现短期并发症10例，长期并发症2例。结论应用术前综合评估方法，有助于准确定位癫痫灶的位置和范围，手术切除癫痫灶疗效稳定。

Objective To review the presurgical evaluation and surgical outcomes in patients with frontal Lobe Epilepsy （FLE）. Methods The data of sixty-eight patients with FLE followed-up more than two years were studied. The preoperative evaluation included semiological feature, MRI, interictal SPECT, video EEG and intracranial recording. The efficacy of the presurgical evaluation was evaluated according to the accurate localization of epileptogenic zone. The accuracy for localization of epileptogenic zones was evaluated based on the data of intracranial ictal EEG, pathological examination, postoperative EEG recordings and clinical follow-up. The surgical outcomes were evaluated according to the Engel Class. Results The proportion of the accurate localization of epileptogenic zone was showed that： 38% for the semiological feature; 40% for MRI; 28% for interictal SPECT; 44% for video EEG and 81% for intracranial EEG recording. Of these patients, focal cortical dysplasia（44%, n = 30）was the most common pathological changes. Surgical outcome showed Engel I in 41 patients （ 60% ）, Engel II in 8 （ 12% ）, Engel m in 7 （10%）and Engel Ⅳ - Ⅴ in 12 （18%）. There were significant differences in surgical outcomes between patients with focal localization and patients with relatively large localization. Transient neurological complications were found in ten patients and permanent complications in two. Conclusions Comprehensiveusing of noninvasive and invasive presurgical evaluation methods is helpful to localize the epileptogenic zone accurately, and the outcome is stable when proper surgery is performed in FLE.