经颞下梭状回入路选择性海马杏仁核切除术治疗颞叶内侧癫痫

Subtemporal selective amygdalohippocampectomy via the fusiform gyrus approach for the treatment of mesial temporal lobe epilepsy

目的探讨经颞下梭状回入路选择性杏仁核海马切除术治疗颞叶内侧癫痫的手术方法、疗效及并发症。方法药物难治性颞叶内侧癫痫30例患者,经颞下切开梭状回,进入侧脑室颞角,选择性切除杏仁核海马及海马旁回等内侧颞叶结构。结果30例患者术后随访至少3年时间(36～61个月),无严重手术并发症。Engel癫痫疗效分级:I级22例(73.3%),II级6例(20%),III级1例(3.3%),IV级1例(3.3%)。结论经颞下梭状回入路选择性杏仁核海马切除术是治疗颞叶内侧癫痫的有效方法,对脑组织创伤小,可妥善保护语言区和视放射,安全性高。

Objective To explore the surgical skills, curative effects and complications of subtemporal selective amygdalohippocampectomy via the fusiform gyrus approach for the treatment of mesial temporal lobe epilepsy （MTLE）. Methods Thirty patients with medically intractable MTLE underwent a selective amygdalohippocampectomy through the fusiform gyrus approach. Results All patients completed at least a 3 years follow-up （range, 36-61 too） after surety and had improved neuropsychological parameters as a result of the operation, with no severe complications. Postoperative control of seizure activities in these 30 patients was as follows： 22 patients （73.3%） were classified as Engel＇s Class Ⅰ, 6 （20%） were classified as Engel＇s classⅡ, 1（3. 3%） as class Ⅲ, and 1（3. 3%） as class IV. Conclusion The fusiform gyrus approach provides the least invasive amygdalohippocampectomy that preserves both the optic radiation and the language area. This approach seems beneficial especially in patients in whom the epileptic lesions are limited to the anterior mesial temporal lobe.