海马横切术与立体定向海马杏仁复合体射频热凝治疗颞叶内侧型癫痫的疗效及神经心理学评估比较

The comparison of effect and neuropsychological evaluations between hippocampal transection and stereotactic radiofrequency thermocoagulation to amygdalohippocampal complex for the treatment of medial temporal lobe epilepsy

目的观察海马横切术与立体定向海马杏仁复合体射频热凝术对顽固性颞叶内侧型癫痫患者的治疗效果及其对认知和记忆功能的影响。方法对12例海马横切术和15例立体定向海马杏仁复合体射频热凝术的癫痫控制率以及手术前后神经心理学检查(包括韦氏智力检查:言语智商VIQ、操作智商PIQ、总智商FIQ和记忆商MQ)结果进行统计分析。结果两组患者术后癫痫控制有效率均可达80%以上,海马横切术的无发作率为66.67%,立体定向海马杏仁复合体射频热凝术组为40%,尚未达到明显统计学差异(P>0.05)。两组手术前后神经心理学检查结果均无显著差异(P>0.05)。结论海马横切术与立体定向海马杏仁复合体射频热凝术治疗顽固性颞叶内侧型癫痫均有效,且对患者认知及记忆等神经功能均无明显损害;海马横切术在癫痫控制方面有明显优势,是一种值得提倡和推广的手术方法,虽然立体定向手术的癫痫发作消失率较低,但并未达到统计学差异,且其微创的特性仍倍受广大颞叶内侧型癫痫患者的青睐。

Objective To observe the outcomes of seizure control and the impairments of cognitive and memorial function of hippocampal transection and stereotactic radiofrequency thermocoagulation to amygdalohippocampal complex for the treatment of intractable medial temporal epilepsy.Methods Twelve cases of hippocampal transection and fifteen cases of stereotactic radiofrequency thermocoagulation to amygdalohippocampal complex performed by the author of this article were collected for statistic analysis of seizure control and neuropsychological examinations(including VIQ:verbal intelligence quotient, PIQ:performance intelligence quotient, FIQ:full intelligence quotient and MQ:memory quotient) before and after operation.Results The effective rates of seizure control were all high than 80%.The seizure free rate was 66.67% in the hipocampal transection group and 40% in stereotactic radiofrequency thermocoagulation to amygdalohippocampal complex group, in which is not yet reached the significant difference(P>0.05).All the neuropsychological examinations’ score before and after operation have no significant difference between the two groups(P>0.05).Conclusion Both Hippocampal transection and stereotactic radiofrequency thermocoagulation to amygdalohippocampal complex were effective for the treatment of medial temporal lobe epilepsy without interfering the neurofunctions of cognize and memory.Hippocampal transection was more excellent in seizure control and worth to be popularized.Although the seizure free rate was relative low in stereotactic radiofrequency thermocoagulation to amygdalohippocampal complex group, but it is not reached the significant difference and the characteristic of microinvasive for this approach was still favorable in a large number of medial temporal lobe epilepsy patients.