单侧颞叶癫癎伽玛刀和定向射频热凝术的效果比较

Comparison between the effects of gamma knife and stereotactic radiofrequency thermo- coagulation for patients with unilateral temporal epilepsy

目的探讨深部电极脑电图证实为单侧颞叶内侧的癫癎患者进行伽玛刀和立体定向射频热凝毁损术疗效的区别。方法：2008年3月～2011年8月，深部电极脑电图确认为单侧颞叶内侧癫癎的患者，据深部电极脑电图所显示的异常范围引导，随机进行伽玛刀治疗和立体定向射频热凝毁损术。伽玛刀治疗颞叶内侧结构时，周边剂量8～13 Gy，平均9．3 Gy，中心剂量16～26 Gy，平均18．5 Gy，50％等剂量曲线；立体定向射频热凝毁损术时，毁损温度70～90℃，平均76．3℃，毁损时间90～120s，平均108．5s，毁损间隔3 mm。结果：术后24～65个月，随访可及的21例伽玛刀治疗，其中癫癎完全缓解（Engel Ⅰ级）2例，癫癎发作很少和几乎消失（EngelⅡ级）3例，显著的改善（Engel Ⅲ级）8例，不显著的改善（Engel Ⅳa级）7例，无改变（Ⅳb级）1例；立体定向射频热凝毁损术10例，其中癫癎完全缓解（Engel Ⅰ级）5例，癫癎发作很少或几乎消失（EngelⅡ级）2例，显著的改善（Engel Ⅲ级）0例，不显著的改善（Engel Ⅳa级）2例，癫癎发作更重（ⅣC级）1例。应用SPSS 17．0分析，两组完全缓解（Engel Ⅰ级）率比较差异有统计学意义（P=0．022），两组完全缓解和癫癎发作很少和几乎消失（Engel Ⅰ级＋Ⅱ级）率比较差异有统计学意义（P=0．021）。结论：对深部电极脑电图证实为单侧颞叶内侧癫癎的患者，SRT的完全缓解率和癫癎基本控制率都高于伽玛刀治疗者。

Objective：To investigate the difference between gamma knife（GK） and stereotactic radiofrequency thermocoagulation for patients with unilateral temporal lobe epilepsy （TLE） confirmed by depth electroencephalogram. Methods： From March 2008 to August 2011, the patients with unilateral temporal lobe epilepsy confirmed by depth EEG were randomly divided into GK group and stereotactic radiofrequency thermocoagulation （SRT） group. To the patients in GK group, dosage given at marginal 50% isodoses was ranged from 8 to 13 Gy （mean 9.3 Gy） covering amygdala, hippocampal head and body, and the central dosage was were 16 to 26 Gy （mean 18.5 Gy） . To the patients in SRT group,the temperature was 70 to 90℃ （mean76.3 ℃） ,the duration was 90 to 120 s （mean 108.5 s）, the interval of thermocoagulation was 3 mm and the targets were amygdala and hippocampal head. Results： With 24 to 65 months follow-up, the postoperative outcomes were evaluted according to Engel classification.. 2 patients reached Engel class I , 3 Engel class II , 8 Engel class III , 7 Engel class IVa, and 1 Engel IVb of the 21 patients in GK group, and 5 patients reached Enget class I , 2 Engel class 11 , 2 Engel class IVa, and 1 Engel IVc of the 10 patients in SRT group. The ratio of Engel I class in the two groups had significantly difference （P=0. 022）, and the ratio of Engel I elass＋Engel 1I class also had significantly difference （P = 0. 021） . Conclusion：To the patients with unilateral TLE confirmed by depth EEG, the result of stercotactic radiofrequency thermocoagulation was better than gamma knife .