双侧颞叶癫痫的外科治疗(附14例临床分析)

Surgical treatment of bitemporal lobe epilepsy

目的研究双侧颞叶癫痫（bitemporal lobe epilepsy,BTLE）的外科治疗方法。方法 l4例BTLE患者经临床症状、视频脑电监测（VEEG）、头颅磁共振（MRI）、磁共振波谱（MRS）、正电子发射断层显像-计算机断层显像（PET-CT）、颅内电极脑电图（IEEG）、术中皮层脑电（ECoG）和深部脑电（DEEG）检查,发现双侧颞叶存在各自独立的致痫灶。对于一侧杏仁核海马复合体及一侧和/或双侧颞叶新皮层中的致痫灶,分别给予选择性杏仁核海马切除术（SAH）和/或多处皮层热灼术（BCFC）联合治疗。结果随访6~24个月,按照Engel的疗效判断标准：l级6例,Ⅱ级3例,Ⅲ级3例,Ⅳ级2例。术后未发生永久性并发症。结论采用选择性杏仁核海马切除术和皮层热灼术联合治疗BTLE是行之有效的。

Objective To explore the effect of surgical treatment of bitemporal lobe epilepsy（BTLE）.Methods Independent epileptogenic foci were found in BTLE by videoelectroencephalogram,magnetic resonance imaging,magnetic resonance spectroscopy,positron emission tomography-computed tomography,intracranial electroencephalogram,intraoperative electrocoticography and depth EEG in 14 patients with intractable epilepsy.Then the BTLE patients were treated with selective amygdalohippocampectomy（SAH）and/or bipolar coagulation on functional cortexes（BCFC）respectively according to the sites of the epileptogenic foci：in the amygdalohippocampus complex or temporal neocortex.Results Followed-up was conducted for 6～24 months.The effects of the 14 patients according to Engel＇s standard were grade I in 6 cases,gradeⅡ in 3 case,grade Ⅲ in 3 cases,and grade IV in 2 case.No permanent complication was found.Conclusion Combination of SAH and BCFC procedures is confirmed and effective in treatment of BTLE.