伽玛刀治疗颞叶癫痫的长期随访

Reviewing the temporal lobe epilepsy patients for long period after the treatment of Gamma-knife

目的 探讨颞叶癫痫的伽玛刀治疗的疗效。方法 用PET、SPECT、MRI、EEG检查痫灶位置 ,应用瑞典ELEKTA公司伽玛刀治疗系统行杏仁核毁损术 (90～ 1 0 0Gy)加颞叶内侧或外侧低剂量 (中心 2 0Gy ,边缘1 0Gy)伽玛射线照射 38例。结果 本组 38例经伽玛刀治疗后随访 5 .1～ 7.2年 ,满意 2 6例 ,显著改善及良好各 3例 ,无效 6例 ,有效率 84 .2 %。其中癫痫完全消失 2 3例 ,占 6 1 % ;1例 3个月后出现精神症状 ,经激素、甘露醇治疗第六个月后症状消失 ;6例 (在满意 2 6例中 ) 2年后癫痫症状同治疗前。无病残及死亡。结论 伽玛刀行杏仁核毁损术加颞叶内侧或外侧低剂量照射 ,对颞叶癫痫具有明确的疗效 ,并发症少见。部分病例的复发可能与杏仁核毁损剂量不足有关。

Objective To discuss the curative effect of the treatment of Gamma knife in temporal lobe epilepsy patient.Methods 38 temporal lobe epilepsy patients were selected.After examination of PET,SPECT,MRI,EEG,we performed stereotactic amygdalotomy(90～100Gy) and irradiated the interior or exterior of the temporal lobe with lower doses (Center dose 20Gy,Margin dose 10Gy) by the Gamma-knife system of ELEKTA Company in Sweden.Results Follow up was accomplished in 38 cases for a duration of 5.1～7.2 years.26 cases were satisfactory,3 cases were ameliorative remarkably,3 cases were benign;6 cases were useless,effective rate is 84.2%.Seizure disappeared completely in 23 cases,accounts for 61%.Psychotic symptom appeared in 1 case,disappeared in 6 months after corticosteroids and mannitol.The epilepsy symptom appeared again in 6 cases (in 26 cases were satisfactory) after 2 years.There was no mortality and deformity.Conclusions Stereotactic amygdalotomy and irradiation the interior or exterior of the temporal lobe with lower doses by the Gamma knife are effective evidently.On the other hand,the complications are few.Epilepsy recrudesced in some patients, which is related to the dose. The dose used in stereotactic amygdalotomy is too low possibly.