岛叶病变伴癫痫发作的手术治疗与癫痫预后

Surgical strategies and seizure outcomes of patients with epilepsy due to insular lesions

目的探讨伴有癫痫发作的岛叶病变患者癫痫发作特点、手术策略及癫痫预后。方法分析18例岛叶病变切除患者的临床表现、手术及癫痫预后等隋况。结果18例患者中14例首发症状为癫痫发作。左侧病变4例，右侧14例。单纯岛叶病变9例。全切11例，次全切7例。星形细胞瘤14例，海绵状血管瘤4例。术后随访11—33个月，13例（72％）癫痫发作完全？肖失。Engel疗效分级：I级13例；Ⅱ级2例；Ⅲ级2例，Ⅳ级1例。结论手术切除岛叶病变，安全可靠，癫痫控制满意。

Objective To explore the clinical manifestation, seizure semiology, surgical strategies and outcomes of patients with epilepsy due to insular lesions. Methods The clinical data of 18 patients who underwent resection of insular lesion between October 2008 and October 2010 were collected. The semiology, MRI and EEG findings, surgical strategies and postoperative follow -up outcomes were evaluated. Results Among 18 patients, 11 patients were female. The seizure was the initial symptom in 14 patients. The lesions of 4 patients （22%） were in the left hemisphere and 14 （78%） in the right. The lesions of 9 patients were within insular , the other 9 extended either to the frontal （ n = 4 ） or temporal lobes （ n = 3 ） or both （ n = 2）. Through transsylvian surgical approach, combined with frontal opereular resection or temporal lobeetomy when necessary, 11 patients （61%） underwent complete resection of the lesions, 6 patients （39%） underwent subtotal resection. 14 patients suffered from glial/glioneural tumors, 4 from cavernomas. The mean follow- up duration was 20. 8 months（ranged from ll to 33 months）. 13 patients （72%） were completely seizure free. Conclusions Resection of insular lesion is acceptably safe and could provide a high rate of satisfactory seizure relief.