导航引导下保留侧脑室完整的颞叶癫痫手术26例体会

Neuronavigator-assisted surgery for temporal lobe epilepsy without opening lateral cerebral ventricle (report of 26 cases)

目的探讨神经导航下保留侧脑室完整的前颞叶海马、杏仁核切除术治疗颞叶癫痫的效果。方法将26例神经导航下保留侧脑室完整的前颞叶海马切除术后患者的术前Wada试验评估、术后并发症及癫痫控制情况进行分析。结果术后随访时间24～36月，EngelⅠ级22例（85％），EngelⅡ级3例（11％），EngelⅢ例（4％）。术后1例（4％）患者出现记忆减退症状，4例患者发生视野缺损。结论同时切除海马、杏仁核的标准前颞叶切除术为外科治疗颞叶癫痫的有效术式，术前Wada试验评估能很好的预测手术对患者记忆功能的影响，保留侧脑室完整的术式可减少视野缺损的发生。

Objective To summarize the experience in treating temporal lobe epilepsy （TLE） by resection of anterior temporal lobe and amygdalohippocampectomy without opening the lateral cerebral ventricle. Methods The language lateralization was performed by Wada test before the surgery in 26 patients with TLE, who underwent neuronavigastor-assisted resection of the anterior temporal lobes and amygdalohippocvampetomy without opening the lateral cerebral ventricle. Results Of 26 patients followed up from 24 to 36 months, 22 had Engel grade I therapeutic outcome, 3 grade Ⅱ and 1 gradeⅢ. The memory declined in 1 patient and the visual field defect occurred in 4 ones after the surgery. Conclusions The resection of the anterior temporal lobe and amygdalohippocampectomy remain a main method to surgically treat TLE. Wada test is helpful to predicting the effect of the surgery on memory function in the patients with TLE. The incidence of visual field defect may be reduced by not opening the lateral cerebral ventricle during the surgery in the patients with TLE.