伽玛刀治疗颞叶癫痫伴精神障碍的疗效分析

Therapeutic effect of gamma-knife surgery on temporal lobe epileptic with psychiatric disorders

目的探讨伽玛刀对颞叶癫痫伴精神障碍的治疗效果。方法回顾分析伽玛刀治疗26例颞叶癫痫伴精神障碍的结果,根据临床特点、PET-CT、EEG进行致痫灶定位,应用MASEP-SRRS型旋转式伽玛刀治疗,单纯以杏仁核和海马为靶点时,边缘剂量25～30Gy,等剂量曲线50%,需加照射颞叶皮层致痫灶时,边缘剂量9～14Gy,等剂量曲线45%～50%。采用癫痫的国内疗效评定标准和全国精神外科疗效评定标准进行疗效评定。结果治疗后随访1～6年,26例中,癫痫控制满意9例,显著改善8例,良好5例,有效率84.6%。治疗后精神症状疗效评定:恢复3例,显著进步12例,进步6例,无效5例,总有效率80.8%。结论伽玛刀行杏仁核海马毁损术及联合皮层癫痫灶低剂量照射,对颞叶癫痫伴精神障碍具有明确的疗效,并发症少见。

Objective To explore the therapeutic effect of gamma-knife surgery on patients with temporal lobe epilepsy and psychiatric disorders.Methods The treatment outcomes of 26 patients with temporal lobe epilepsy and psychiatric disorders treated by MASEP-SRRS gamma knife were retrospectively analyzed.The epileptogenic focus was localized by characteristics of epileptic seizure,PET-CT,EEG.Marginal dose of 25~30 Gy to isodose line of 50% was managed when target was pointed to the amygdala and hippocampus,and 9~14 Gy to 45%~50% was managed to the epileptogenic focus if necessary.The therapeutic effect were estimated using national standard.Results Follow-up was accomplished in 26 cases for a duration of 1.0~6.0 years.9 cases were satisfactory,8 cases were ameliorative remarkably,5 cases were benign,4 cases were useless,effective rate is 84.6%.The psychiatric disorders disappeared in 3 cases,significantly improved in 12 cases,Improved in 6 cases and 5 were of no improvement.The effective rate was 80.8%.Conclusion Stereotactic amygdala hippocampus irradiation and association cortex of epileptic foci with lower doses by the gamma-knife are effective evidently on temporal lobe epileptic with psychiatric disorders.On the other hand,the complications are few.