不同手术入路治疗海马硬化性颞叶内侧癫痫的比较

Surgical treatment of mesial temporal lobe epilepsy using different approaches

目的比较常用的四种手术方式在治疗海马硬化性颞叶内侧癫痫（MTLE／HS）中的优缺点。方法106例顽固性MTLE／HS患者中23例行经皮层脑室入路选择性海马杏仁核切除术；23例行经侧裂选择性海马杏仁核切除术；30例行前内侧颞叶切除术；30例行经颞下选择性海马杏仁核切除术。随访6个月-9年。采用Engel分级量表评价癫痫治疗效果，并比较并发症发生率。结果四种术式在对癫痫发作的治疗效果比较上差异无统计学意义，无手术死亡，在并发症发生率方面差异无统计学意义。结论对于经严格筛选的MTLE／HS，四种手术方式在疗效和安全性方面相当，可根据个人手术经验加以选择。

Objective To compare the advantages and disadvantages of four surgical approaches employed at present in the treatment of mesial temporal lobe epilepsy associated with hippocampal sclerosis （MTLE/HS）. Methods Based on seizure history, seizure semiology, findings with long - term video - EEG monitoring and high resonance MRI scanning, 106 patients with refractory MTLE/HS were consecutively selected and operated on for seizures. 23, 23, 30 and 30 patients underwent selective transcortical transventricular amygdalohippocampectomy, selective transsylvian fissure amygdalohippocampectomy, anterior medial temporal resection and transsubtemporal selective amygdalohippocampectomy respectively. All patients were followed up from 6 months to 9 years. Engel＇ s scale was employed for the evaluation of postoperative outcomes. All postoperative complications were analyzed according to prospectively documented data. Results The routine pathological study showed typical changes of hippocampal sclerosis. Regarding outcomes with respect to seizure control, the four surgical methods were not statistically different with high frequency of seizure freedom in this special epileptic syndrome. There was no surgical mortality. The main surgical complications included diplopia and intracranial infection. All these complications were transient and cured, and had no significant difference in occurrence among 4 groups. Conclusions In strictly selected patients with MTLE/HS, all the four surgical methods are highly effective and safe. At least at the begaining of performence of epilepsy surgery, these four procedures could be chosen based on surgical experiences of operators.