颞顶枕叶离断术治疗后头部药物难治性癫痫的临床疗效

Clinical efficacy of temporoparietooccipital disconnection in the treatment of posterior quadrantic intractable epilepsy

目的:探讨颞顶枕叶离断术治疗后头部药物难治性癫痫的临床疗效。方法:连续性纳入北京丰台医院神经外科2015年1月至2018年6月采用颞顶枕叶离断术治疗的16例后头部药物难治性癫痫患者。回顾性观察手术相关并发症,采用Engel分级评估患者的预后(Ⅰ级为无发作,Ⅱ~Ⅳ级为复发)。结果:16例患者均成功行颞顶枕离断术。术后3例出现对侧肢体运动功能障碍,所有患者术后均出现对侧偏盲,1例出现一过性Gerstmann综合征,无一例患者发生颅内感染和脑积水。16例患者术后随访时间为(26.3±2.4)个月(20~60个月)。围手术期癫痫控制均良好;术后3个月首次随访癫痫无发作者14例,复发2例;末次随访癫痫无发作者12例,复发4例,其中Engel分级Ⅱ级者2例,Ⅲ级者2例。术后发生对侧肢体运动功能障碍的3例患者,随访期间运动功能均有所改善;出现一过性Gerstmann综合征者3个月后基本恢复。结论:颞顶枕叶离断术是治疗后头部药物难治性癫痫相对安全、有效的方法。

Objective To investigate the clinical efficacy of temporoparietooccipital disconnection in the treatment of posterior quadrantic intractable epilepsy.Methods The clinical data of 16 patients who underwent temporoparietooccipital disconnection at the Neurosurgery Department of Beijing Fengtai Hospital from January 2015 to June 2018 were included consecutively.The surgery-related complications were observed retrospectively,and the outcome of the patients was evaluated using the Engel scale(gradeⅠ:no seizure;gradeⅡ-Ⅳ,seizure recurrence).Results All 16 patients successfully underwent temporoparietooccipital dissection.Three patints developed contralateral limb motor dysfunction,all patients developed contralateral hemianopia after operation,one patient developed transient Gerstmann syndrome,and none of the patients developed infection or hydrocephalus.The follow-up time of 16 patients was 26.3±2.4 months(20-60 months).Postoperative seizure control was good,there were 14 seizure-free patients and 2 patients with seizure recurrence at the first follow-up at 3 months post operation.At the last follow-up,there were 12 patients with seizure-free and 4 patients with seizure recurrence including 2 cases of Engel gradeⅡand 2 cases of gradeⅢ.In 3 patients with contralateral limb motor dysfunction after operation,their motor function improved during the follow-up period.None of the patients recovered from contralateral hemianopia.The patients with transient Gerstmann syndrome basically recovered after 3 months.Conclusion Temporoparietooccipital disconnection seems to be a safe and effective method for the treatment of posterior quadrantic intractable epilepsy.