立体定向杏仁核海马毁损术治疗颞叶内侧型癫痫的临床研究

Stereotactic lesioning of the amygadala and hippocampus in patients with epilepsy of the mesial temporal lobe

目的探讨立体定向杏仁核海马毁损术治疗颞叶内侧型癫痫的有效性，同时评价深部电极记录的发作间歇期痫性放电定位致痫灶的准确性。方法选择南方医院神经外科门诊自1998年7月至2003年10月收治的21例顽固性颞叶癫痫患者，行立体定向杏仁核海马毁损术。术中在毁损靶点前后行深部电极记录，统计发作间歇期痫性放电发生频率。结果术后随访21例，其中EngelⅠ级6例，Ⅱ级2例，Ⅲ级5例，Ⅳ级3例，Ⅴ级5例。有效者（Ⅰ＋Ⅱ＋Ⅲ级）13例，无效者（Ⅳ＋Ⅴ级）18例，有效率为62％。深部电极记录的发作间歇期痫性放电手术前后的发生频率差异无统计学意义（P〉0．05）。结论立体定向射频毁损杏仁核海马手术治疗颞叶内侧型癫痫安全有效。深部电极记录的发作间歇期痫性放电定侧价值较高，而定位价值低。

Objective To investigate the efficacy of stereotactic lesioning of the amygadala and hippocampus for treatment of epilepsy in the mesial temporal lobe, and explore the accuracy of lateralization and localization of interictal epileptic discharge recorded by depth electrode. Methods Twenty-one patients with intractable epilepsy of the temporal lobe, admitted to our hospital from July 1998 to October 2003 and underwent stereotactic lesioning of the amygadala and hippoeampus, were chosen in our study. The frequentey of Interictal epileptic discharge recorded by depth electrode and occurred preoperatively and postoperatively were compared. Results Follow-up was performed in 21 patients： 6 with Engel I, 2 with Engel II, 5 with Engel III, 3 with Engel IV and 5 with Engel V. Thirteen patients enjoyed good effect and ineffective result was noted in 8, with an effective rate reaching 62%. No consistent changes of interictal epileptic discharge recorded by depth electrode occurred preoperatively. Conclusion Stereotactic lesioning of the amygadala and hippocampus is safe and effective in treating patients with epilepsy in the mesial temporal lobe. The interictal epileptic discharge can supply useful lateralizing information, but has little localizing value.