经立体脑电图证实的双侧颞叶癫痫外科疗效观察

Observation on the surgical efficacy of bilateral temporal lobe epilepsy confirmed by stereoelectroen-cephalography

目的 探讨外科手术治疗经立体脑电图(SEEG)证实的双侧颞叶癫痫(SEEG-BTLE)的方法和疗效.方法 纳入2019年6月至2023年3月陆军军医大学第二附属医院神经外科治疗的经SEEG证实的BTLE(SEEG-BTLE)患者,共13例.其中采用单侧前颞叶切除术(AMTL)5例(均为癫痫发作起源偏侧化明显);SEEG引导下射频热凝(RFTC)术6例(癫痫发作起源偏侧化不明显或拒绝切除术);神经调控2例,其中脑深部电刺激(DBS)1例,迷走神经电刺激(VNS)1例(均为癫痫发作起源偏侧化不明显).回顾性分析患者的临床资料及疗效.切除术和RFTC术的疗效采用Engle分级标准评估,Ⅰ~Ⅱ级为疗效良好,Ⅲ~Ⅳ级为疗效不佳;神经调控按McHugh分级标准评估,Ⅰ~Ⅱ级为疗效良好,Ⅲ~V级为疗效不佳.结果 5例行单侧AMTL的患者术后随访14~45个月,Engle分级Ⅰ级3例、Ⅲ级2例;2例出现记忆力减退.6例行RFTC术的患者随访6~31个月,Engle分级Ⅰ级1例、Ⅱ级1例、Ⅲ级2例、Ⅳ级2例;1例出现记忆力减退.接受DBS和VNS的2例患者,分别随访35、38个月,均为McHugh分级Ⅲ A级.结论 初步研究显示,采用个体化原则治疗SEEG-BTLE,其中采用单侧AMTL者的疗效较好,采用RFTC者的疗效尚可,神经调控治疗可能具有一定疗效.

Objective To explore the methods and efficacy of surgical treatment of bilateral temporal lobe epilepsy(SEEG-BTLE)confirmed by stereoelectroencephalography(SEEG).Methods A total of 13 patients with SEEG-BTLE were treated at the Department of Neurosurgery,the Second Affiliated Hospital of Army Military Medical University from June 2019 to March 2023.Among them,5 cases with obvious lateralization of the origin of epileptic seizures underwent unilateral anterior temporal lobe resection,6 cases who had no obvious lateralization of the origin of epileptic seizures or refused resection underwent SEEG-guided radiofrequency thermocoagulation.There were 2 cases undergoing neuromodulation,including 1 case of deep brain stimulation(DBS)and 1 case of vagus nerve stimulation(VNS).In both cases,the origin of epileptic seizures could not be obviously lateralized.The clinical data and efficacy of patients were retrospectively analyzed.The efficacy of resection and radiofrequency thermocoagulation was evaluated using the Engle grading standard,with grades Ⅰ to Ⅱ representing good efficacy and grades Ⅲ to Ⅳ representing poor efficacy.Neuromodulation efficacy was evaluated according to the McHugh grading standard.Grades Ⅰ to Ⅱ indicated good efficacy and grades Ⅲ to Ⅴ indicated poor effect.Results Five patients who underwent unilateral anterior temporal lobectomy were followed up for 14 to 45 months.There were 3 cases of Engle grade Ⅰ and 2 cases of Engle grade Ⅲ.Memory decline occurred in 2 cases.The follow-up time of 6 patients who underwent radiofrequency thermocoagulation ranged from 6 to 31 months.One case was Engle grade Ⅰ,1 was Engle grade Ⅱ,2 were grade Ⅲ,and 2 were grade Ⅳ.One patient had memory decline.The two patients who received DBS and VNS had follow-up times of 35 and 38 months respectively,and both were McHugh class ⅢA.Conclusions Preliminary research shows that individualized principles should be used to treat SEEG-BTLE.The efficacy of lesion resection in unilateral temporal lobe is relatively better,the efficacy of radiofrequency thermocoagulation is acceptable,and neuromodulation therapy may have certain efficacy.