颞叶相关癫痫37例手术疗效分析

The surgical outcome studies of epilepsy correlated with temporal lobe:37 cases reports

目的分析影响与颞叶相关癫痫患者手术疗效的相关因素,探讨不同类型颞叶相关癫痫的手术效果。方法对37例颞叶相关癫痫患者依据神经影像学、临床症状学及神经电生理、神经心理学进行术前术后综合评估,术前、术后进行对照分析,判定手术疗效。结果术后病理海马硬化3例,囊肿1例,低级别胶质瘤2例,胚胎发育不良性神经上皮肿瘤1例,脑软化灶3例,胶质细胞增生、皮层分层紊乱23例,海绵状血管瘤3例,慢性炎性细胞浸润1例。术后随访一年以上,Engel I级18例,Engel II级16例,Engel III级2例,Engel IV级1例。无严重并发症及手术死亡病例。2例出现并发症:短暂性记忆减退1例,出院时已完全恢复至术前水平,精神障碍加重1例。结论影响术后疗效的主要因素在于对神经影像学、临床症状学及电生理学的正确判读,三者定位一致的颞叶相关癫痫患者和颞叶影像学有阳性发现的患者,术后疗效较好;对于颞叶影像学有结构性病变,但临床症状表现为全面性发作的患者,选择正确的手术方式,仍可取得满意疗效。

Objective To analyze the influence factors of surgical outcome in correlated with temporal lobe epilepsy patients, and discuss the effect of surgical treatment in different types of correlated with temporal lobe epilepsy. Methods 37 patients with epilepsy correlated with temporal lobe underwent preoperative and postoperative evaluation, nincluding these aspects： neuroimaging, clinical symptoms neuro--electrophysiology and neuropsychology, then analyze the clinical outcome. Results All patients had more than othe year follow--up after surgery. We found 18 cases were seizure free （Engel I）, seizure frequency reduced markedly in 16 cases （Engel II）, 2 cases in Engel III and 1 case had no effect（Engel IV） . Conclusion The main influence factor of surgical outcome in correlated with temporal lobe epilepsy patients was correct interpretation of neuroimaging, clinical symptoms neuro--electrophysiology and neuropsychology. When these aspects were highly consistent in localizing epileptogeniczone and in cases there were neuroimging structural abnormalities,we would find better surgical effect. Severity of epilepsy complications may influence the postoperative effect, less complications, postoperative effect was relatively better. For those cases there were neuroimging structural abnormalities but clinical symptoms were generalized seizures, correct resections also led to good effect.