经颧弓翼点入路选择性海马杏仁核切除治疗颞叶癫痫

Selective Amygdalohippocampectomy through Transzygomatic-pterion Approach for the Treatment of Temporal Lobe Epilepsy

目的探讨经颧弓翼点入路行选择性海马杏仁核切除治疗颞叶癫痫的手术方法、术后疗效及并发症.方法本组26例,其中男12例,女14例,年龄4～48岁(平均21.3岁).病程1～20年(平均8.4年).临床表现强直-阵挛性发作20例,失神发作4例,复杂部分性发作2例.所有患者术前均行CT及MRI检查和EEG检查,还有4例患者行了脑磁图检查.手术采用改良翼点入路切口,下端达颧弓下,游离出颧弓2 cm后用线锯锯下,将前海马和杏仁核基底外侧分块取出,并将海马旁回及钩回逐步吸除,术毕颧弓复位生物胶固定.结果26例患者中,除3例术后出现颧弓处皮肤肿胀、疼痛外,其余23例患者恢复良好.经过1年以上的随访,发现20例癫痫发作完全消失,4例术后较术前显著改善,1例术后效果良好,手术效果较差1例.手术总有效率96.1%(25/26),优良率92.2%(24/26).结论经颧弓翼点入路行选择性海马杏仁核切除术治疗颞叶癫痫是一种安全、有效的手术方式,术后并发症少,疗效满意.

Objective To explore the method, curative effect and complication of selective amygdalohippocampectomy (SelAH) through transzygomatic-pterion approach for the treatment of temporal lobe epilepsy (TLE). Method Of 26 patients with TLE, 12 were male and 14 female. Their ages ranged from 4 to 48 years (mean 21.3), and their illness lasted 1～20 years (mean 8.4). There were tonicoclonic seizure in 20 cases, absence seizure in 4 and complex partial seizure in 2. Before the operation all the patients received CT, MRI and EEG examinations and 4 cases received MEG examination. The anterior hippocampus and basolateral portion of the amygdale were excised along with the parahippocampal gyrus and uncus by the operation through the improved pterion approach. Results Of 26 patients with TLE, who underwent SelAH, 23 recovered well postoperatively, and 3 had pain and intumesce in the skin of the operation incision. During the followed up for more than one year, 20 patients did not suffered from seizure, 4 were significantly improved, 1 good and 1 bad. Totally effective rate was 96.1% (25/26). Conclusions SelAH through thranszygomatic-pterion approach for the treatment of TLE is a safe and effective way. The postoperative complication is less and the outcome is satisfactory.