症状性颞叶癫痫显微外科手术疗效分析

Analysis on curative effects of microsurgery for symptomatic temporal lobe epilepsy

目的分析症状性颞叶癫痫显微外科手术的术前评估方式、手术方式以及疗效的相关影响因素。方法选取2014年8月~2018年8月我院收治的症状性颞叶癫痫患者25例,其中难治性病例12例,所有患者均行显微手术治疗,其中包含海马病变/硬化的患者行标准前颞叶及内侧结构切除,不包含海马病变/硬化的患者行病灶+致痫灶切除治疗。术后均随访3个月~2年以上,将Engel'S分级情况作为依据,对患者预后进行评价,可分为非满意组(患者分级Ⅲ,Ⅳ级)与满意组(患者分级为Ⅰ,Ⅱ级),分析患者脑电图监测等情况、影像学改变情况以及术前发作的具体形式,以及手术方式的选择等因素对手术疗效的影响。结果经手术治疗后,25例患者中无偏瘫、偏盲、失语或记忆力明显减退症状,有3例出现短期性精神障碍症状,经治疗后好转;25例患者Engel'S分级为Ⅰ级、Ⅱ级、Ⅲ级、Ⅳ级的患者分别有20、2、2、1例,构成比分别为80%、8%、8%、4%,满意组患者共有22例,非满意组患者有3例;满意组术前共有2例患者出现继发性强直阵挛发作,构成比为18.18%,非满意组发生率为66.67%(8/12),组间差异有统计学意义(χ2=8.6257,P<0.05);满意组术前IZ局限于单侧颞区构成比高于非满意组,继发性强直阵挛发作、有双重影像学改变出现患者构成比低于非满意组,P<0.05。结论术前进行严格的术前评估,利于将标准前颞叶及内侧结构切除的临床疗效提高;行病灶并致痫灶手术方式的使用术中皮质电生理监测下处理致痫灶可明显提高手术效果。

Objective To analyze the preoperative evaluation methods, surgical methods and related influencing factors of curative effects of microsurgery for symptomatic temporal lobe epilepsy. Methods 25 patients with symptomatic temporal lobe epilepsy who were admitted and treated in our hospital from August 2014 to August 2018 were selected,including 12 refractory cases.All patients underwent microsurgery.Patients with hippocampal lesions/sclerosis underwent standard anterior temporal lobe and medial structural resection.Patients without hippocampal lesions/sclerosis underwent resection of lesions and epileptogenic focus.All patients were followed up for 3 months to 2 years.Based on Engel'S classification,the prognosis of patients was evaluated.They were divided into non-satisfied group (patient of grade Ⅲ and Ⅳ) and satisfied group (patient of grade Ⅰ and Ⅱ).EEG monitoring,imaging changes and the specific form of preoperative seizures of patients were analyzed.The effect of surgical methods and other factors on the surgical curative effects was also analyzed. Results After surgery,25 patients all had no hemiplegia,hemianopia,aphasia or significant memory loss symptoms and 3 patients had short-term mental disorder symptoms, and their symptoms were improved after treatment.Patients with Engel'S grading of grade Ⅰ,grade Ⅱ,grade Ⅲ,and grade Ⅳ were 20,2,2,and 1 case,respectively,with a composition ratio of 80%,8%,8%,and 4%,respectively.There were 22 patients in the satisfied group and 3 patients in the non-satisfied group.2 patients in the satisfied group had a secondary tonic-clonic seizure before the operation,and the composition ratio was 18.18%.The incidence of non-satisfied group was 66.67%(8/12).There were statistically significant differences between groups(χ2=8.6257,P < 0.05).In the satisfied group, the composition ratio of preoperative IZ limited to the unilateral temporal region was higher than that of the non-satisfied group.The composition ratios of secondary tonic-clonic seizure and dual imaging changes in the satisfied group was lower than those of the non-satisfied group (P < 0.05). Conclusion Strict preoperative evaluation before surgery is beneficial to improve the clinical curative effects of standard anterior temporal lobe and medial structural resection.Treatment of epileptogenic foci with intraoperative cortical electrophysiological monitoring can significantly improve the surgical effects of resection of lesions and epileptogenic focus.