深部电极引导立体定向手术治疗颞叶癫癎

Deep-brain electrode-guided stereotactic surgery for intractable temporal lobe epilepsy

目的评价深部电极引导立体定向手术治疗颞叶癫癎的疗效。方法对94例无明显病灶的颞叶癫癎病人采用深部电极引导立体定向海马杏仁复合体热凝毁损术,术后随访癫癎控制效果。对其中27例行手术前后神经心理学检查,评价手术对脑功能的影响。结果80例获1～7年随访,其中发作完全消失47例(58.8%),减少75%以上18例(22.5%),减少50%～75%9例(11.2%),无变化6例(7.5%)。神经心理学检查表明手术前后智力、记忆力差异无统计学意义(均P>0.05)。结论选择合理手术入路及术中应用深部电极取代以往的解剖学定位,达到理想有效的毁损范围,有助于提高颞叶癫癎的手术疗效。

Objective To evaluate therapeutic efficacy of deep-brain electrode-guided stereotactic surgery for intractable temporal lobe epilepsy. Methods Ninety-four patients with temporal lobe epilepsy without structural lesions were treated with deep-brain electrode-guided stereotactic heat coagulation for lesioning amygdala-hippocampus complex, and followed-up for observing seizure control. Twenty-seven out of the 94 patients underwent neuropsychological examinations before and after the operation for assessing the influence of surgery on brain function. Results Eighty patients were followed-up for 1-7 years. Complete control of seizures was achieved in 47 patients （58.8%）, significant reduction （〉75%） in 18 （22.5%）, reduction （50-75%） in 9 （11.2%）, and no change occurred in 6 （7.5%）. The neuropsychnlogical examination showed no significant difference in intelligence and memory before and after the surgery （P 〉 0.05）. Conclusion Choosing a reasonable surgical approach and using deep-seated recording electrode for functional localization instead of anatomical localization to achieve an ideal lesion area are the key factors to improve the therapeutic efficacy of surgery for temporal lobe epilepsy.