颞叶新皮质癫痫的手术治疗

Surgical Treatment of Neocortical Temporal Lobe Epilepsy

目的总结新皮质颞叶癫痫病人临床特征、手术方法和疗效。方法对28例新皮质颞叶癫痫病人术前行电生理学、影像学、脑磁图(MEG)定位以及术中皮层和深部电极描记,采取病灶切除加周围皮质切除术、皮质切除术、病灶切除加多处软膜下横切术以及多处软膜下横切术进行治疗,并进行3个月～2年的随访观察。结果28例颞叶新皮质癫痫经手术和病理证实,其中患胶质增生9例,胶质细胞瘤8例,血管畸形5例,新生儿缺氧性脑损害和外伤后脑膜脑瘢痕3例,灰质异位1例,无结构性病变2例。无手术致残和死亡。随访3～24个月后,根据Engel等人的标准分类,Ⅰ级16例,Ⅱ级6例,Ⅲ级4例,Ⅳ级2例。结论根据电生理学、影像学和MEG准确颞叶定位,采取不同术式治疗新皮质颞叶癫痫可达到良好的治疗效果。

Objective To explore the clinical features,method and outcomes of surgical treatment of neocortical temporal lobe epilepsy(NCTLE).Methods Epileptogentic foci were exactly localized by EEG,MRI,magnetoencephalography(MEG),and intraoperative electrocorticography(ECOG)and depth EEG(DEEG).The resection of the foci and cortex surrounding them,or corticectomy,or the foci resection and multiple subpial transactions were performed in the patients with NCTLE.All the patients were followed up from3months to2years.Results The operation and pathological examination confirmed that of28patients with NCTLE,9suffered from gliosis,8gliocytoma,5vascular malformations,3anoxic and ischemic cerebral lesion,or scar secondary to cerebral injury,1cortical heterotopia and2was structurally not found intracranially abnormal.ClassⅠwas16,classⅡ6,classⅢ4and classⅣ2according to Engel classification.No patients dead and was disabled due to the operation.Conclusion All the outcomes of the different operations,which were perforemed according to the lesions localized by electrophysiology,MRI and MEG,are good in the patients with NCTLE.