颞叶癫痫术前评估对手术效果的影响

The effect of preoperative assessment of temporal lobe epilepsy on surgical outcome

目的探讨神经影像学及神经电生理学资料在颞叶癫痫术前评估中的作用。方法回顾性分析63例吉林大学第一附属医院自2013年1月-2015年1月收治的颞叶癫痫患者术前神经影像学及神经电生理学的临床资料,确定手术切除范围,随访手术效果。结果长程视频脑电（V-EEG）结果显示,异常放电一侧占优势患者53例,术后随访均为EngelⅠ-Ⅱ级。头部MRI检查提示一侧颞区结构性病变（包括海马硬化）58例,术后随访EngelⅠ-Ⅱ级为55例。所有患者术后随访3~12个月,EngelⅠ级43例,EngelⅡ级12例,EngelⅢ级4例,EngelⅣ级4例,疗效满意。结论术前长程视频脑电（V-EEG）、头部MRI检查在颞叶癫痫术前定位中非常重要,而二者相结合,必要时辅以颅内电极EEG定位,是准确、可靠的癫痫灶定位方法。

Objective To investigate the role of neuroimaging and neuro-electrophysiology in the preoperative assessment of temporal lobe epilepsy. Methods Respectively analysing imaging and clinical data of 63 patients with intractable temporal lobe epilepsy,who were admitted to the first hospital of Jilin university from January 2013 to January 2015. And determining the scope of surgical resection and following-up results. Results Long period video EEG（ V-EEG） results show that unilateral epileptiform discharges in 53 patients（ following-up of 53 patients are Engel Ⅰ-Ⅱ）. MRI demonstrate unilateral temporal lobe lesions（ including hippocampal sclerosis） in 58 cases（ following-up of 55 patients are Engel Ⅰ-Ⅱ）. After following-up 3-12 months,We found 43 cases were seizure free（ Engel Ⅰ）,seizure frequency reduced markedly in 12 cases（ Engel Ⅱ）,4 cases in Engel Ⅲ and 3 case had no effect（ Engel Ⅳ）. Conclusion Preoperative long period video electroencephalogram（ V-EEG） and MRI examination is very important in the preoperative localization of temporal lobe epilepsy. And the combinations of preoperative V-EEG,MRI and intracranial electrode EEG are accurate and reliable method of localization of epileptic foci.