立体定向双侧海马杏仁核复合体毁损术治疗双颞叶内侧型癫痫

Bilateral stereotactic radiofrequency amygdalohippocampectomy for the treatment of bilateral medial temporal lobe epilepsy

目的：评价双侧海马杏仁复合体毁损术治疗双颞叶内侧型癫痫的疗效与安全性。方法：对实施双侧海马杏仁复合体小体积毁损术的12例双颞叶内侧型癫痫患者进行回顾性分析．通过Engel分级与Liverpool癫痫严重程度量表2．0（LESS2．0）评价癫痫控制效果，并通过韦氏成人智力量表及记忆量表判定手术对脑功能的影响。结果：随访时间12～62个月，5例患者发作消失（EngeII级），另7例仍有癫痫发作者，LESS2．0评分明显下降（P〈0．05）；术后暂时智力与记忆力有轻度下降，但无统计学意义（P〉0．05），而在术后6个月则均明显提高（P〈0．05）。结论：双侧海马杏仁复合体毁损术可终止或减少双颞叶内侧型癫痫的发作，在小体积毁损的前提下，神经心理学功能并无严重影响．甚至随着癫痫发作的控制而有所提高。

Objective To retrospectively analyze the effect and safety of bilateral stereotactic radiofrequency amygdalohippocampectomy （SAHE） for treatment of bilateral medial temporal lobe epilepsy （BMTLE）. Methods Twelve BMTLE patients were treated with bilateral SAHE under limited coagulations. Clinical parameters were evaluated with the programs of Engel＇s classification, Liverpool Seizure Severity Scale （LSSS） 2.0, Wechsler Adult Intelligence Scale-Revised （WAIS-R） and Wechsler Memory Scale-Revised （WMS-R）, respectively. Results Five patients （42%） were assessed as Engel I with 12 - 62-month follow-up. Seizure severity scores were declined sharply compared with the baseline of the patients with out seizure free. Function of memory and intelligence was transiently declined without statistical significance immediately after operation （P 〉 0.05）, but was significantly increasedat 6 months after operation （P 〈 0.05）. Conclusion Bilateral SAHE could terminate seizures or reduce seizure severity in patients with BMTLE. Under the circumstance of limited coagulations, neuropsychological function was improved along with seizure control.