术中磁共振导航辅助显微外科手术治疗颞叶内侧型癫痫

Microsurgical treatment of mesial temporal lobe epilepsy under the guidance of intraoperative magnetic resonance imaging neuronavigation system

目的探讨术中磁共振影像神经导航系统在辅助显微外科手术治疗颞叶内侧型癫痫的应用价值。方法对26例诊断明确的难治性颞叶内侧型癫痫患者，采用术中磁共振影像实时神经导航辅助，结合术中脑电图监测，行显微外科手术切除前内侧颞叶、海马及杏仁核。结果26例患者术后复查核磁均显示前内侧颞叶切除满意，病理证实内侧结构萎缩或硬化：本组患者随访12个月以上．癫痫发作完全消失者（Engel Ⅰ级）23例（88．5％），癫痫发作极少者（EngelⅡ级）2例（7．7％），癫痫发作有手术价值的减少者（Engel Ⅲ级）1例（3．8％）。患者均未出现严重的手术并发症，神经功能保持良好。结论术中磁共振导航辅助显微外科手术治疗颞叶内侧型癫痫，既能彻底切除致痫灶，又能有效地保留神经功能，提高了手术的准确性与安全性。

Objective To explore the applied effects of microsurgical treatment on mesial temporal lobe epilepsy （MTLE） under the guidance of the intraoperative magnetic resonance imaging neuronavigation system. Methods The anterolateral temporal lobe, hippoeampus anti amygdala was resected by microsurgery under the guidance of the intraoperafive magnetic resonance imaging neuronavigafion system in 26 patients with intractable MTLE, with the help of electroeorficography monitoring during operation. Results Antero- lateral temporal lobes were all resected in postoperative MRI and mesial structures certified to have atrophy or cirrhosis by pathology. All the patients were followed up fi＇om 3 to 6 months after the surgery. In 26 patients, twenty-three cases （88.5%） belonged in Engel grade I, two cases （7.7%） in grade II and 1 case （3.8%） in grade III. No severe complications occun＇ed and nervous functions were preserved well. Conclusion Microsurgical treatment on MTLE under the guidance of the intraoperative magnetic resonance imaging neuronavigation system is effective due to epileptic locus all resected and protection for nervous functions, resulting in an accurate and safe improvemention of operation.