前颞叶加海马切除术治疗顽固性颞叶癫痫的疗效

Curative efficacy of anterior temporal lobe and hippocampus resection for intractable temporal lobe epilepsy

目的探讨前颞叶加海马切除术治疗顽固性颞叶癫痫的疗效。方法回顾性分析46例顽固性颞叶癫痫患者的临床资料,术前行视频脑电图(V-EEG)、磁共振(MRI)、正电子发射计算机断层成像(PET)、单光子发射计算机断层成像(SPECT)等检查,进行术前综合评估。取扩大翼点入路,术中在皮层脑电监测(ECo G)下行前颞叶加海马切除术。术后随访6~24个月。结果本组46例无手术死亡和严重的并发症。疗效按Engel分级:I级37例(80.43%),Ⅱ级5例(10.87%),Ⅲ级2例(4.35%),Ⅳ级2例(4.35%)。结果前颞叶加海马切除术治疗顽固性颞叶癫痫效果显著,综合的术前评估对致痫灶的准确定位是提高疗效的关键,对颞叶解剖结构的深刻认识及精细娴熟的手术操作技巧可减少术后并发症的发生。

Objective The curative efficacy of anterior temporal lobe and hippocampus resection for intractable temporal lobe epilepsy was discussed. Methods The data of 46 patients with intractable temporal lobe epilepsy was analyzed, and all these patients were conducted video electroencephalogrmn （V-EEG）, magnetic resonance imaging （MRI）, positron emission tomography （PET） and single photon enission computed tomography （SPECF） for pre- operative comprehensive evaluation. Extensive pterional approach was applied in the surgery, mad anterior temporal lobe and hippocampus resection was implemented by the ,nonitoring of electrocorticogram （ECoG） during operation. After operation, all the patients were followed up for 6 months to 24 months. Results Out of 46 patients, no patients died during operation and no obvious complications occurred. According to Engel classification, there were 37 cases （80.43%） of Class I, 5 cases （10.87%） of Class Ⅱ, 2 cases （4.35%） of Class Ⅲ, and 2 cases （4.35%） of Class IV. Conclusion Anterior temporal lobe and hippocampus resection is effective in the treatment of patients with intractable temporal lobe epilepsy. Comprehensive pre-operative assessment for the accurate location of epileptogenic loci is the key to improve the curative efficacy, and the protbtmd understanding for anatomical structure of temporal lobe and refined surgical skills can reduce the incidence of post-operative complications.