儿童颞叶症状性癫痫的手术治疗

Surgical treatment for symptomatic temporal lobe epilepsy in children

目的 探讨儿童颞叶症状性癫痫的原因和临床特征并总结手术治疗经验。方法 对我院自1994年1月至2002年8月手术治疗的17例儿童颞叶症状性癫痫,男11例,女6例,年龄3～14岁,平均9岁,均以癫痫为首发症状,病程 13 d到 7年,平均为4.3年。手术方式为:单纯病灶切除6例,病灶加前颞叶切除11例,其中13例再行皮层脑电极检查,12例仍发现致痫波,则加大病灶切除范围和/或病灶周围皮质区多处软膜下横纤维切断。结果 17例患儿无手术死亡及并发症。随访16例,时间为 6个月～7年,术后症状完全消失者 12例(占70.6％),术后癫痫发作显著减少者(发作频率不到原来的25％)3例(17.6％),术后癫痫发作减少者(发作频率不到原来的50％)2例(11.8％)。结论 在皮层脑电极监测下,多种手术方法结合治疗颞叶症状性癫痫患儿安全有效。

Objective To investigate the experience in surgical treatment of symptomatic temporal lobe epilepsy in children. Methods A retrospective analysis was made of 17 children ( 11 boys and 6 girls) with secondary temporal lobe epilepsy who were operated on from January 1994 to August 2002. The age ranged from 3～14 years with an average of 9 years. Of them, 6 cases underwent lesionectomy and 11 pa- tients had lesionectomy combined with anterior temporal lobectomy. Twelve patients who had abnormal wave demonstrated by cortical electrode after operation and received corticectomy for focus of epilepsy and/ or multiple subpartial corticectomy. Results No complication or mortality was happened in all patients. The follow-up results of 16 patients showed a complete seizure control obtained in 12 cases (70.6%), obvi- ous decreased in 3 (17.6 %), and less control in 2 (11.8 %). Conclusion For secondary temporal lobe epilepsy in children, the combined operations are effective to seizure control as safe as regular seizure surgery under the monitor of cortical electrode.