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目的总结并分析难治性颞叶癫痫患者术前定位、手术方式和经验。方法回顾性分析2009年6月至2011年6月,采用颞前叶+海马杏仁核切除术治疗的颞叶癫痫病人35例,其中术前MRI及术后病理证实伴有海马硬化者32例,所有病例术中均在皮层电极监测下切除颞叶皮质及同侧海马、杏仁核,手术后均应用抗癫痫药物治疗,术后随访1～3年。结果在35随访病例中,癫痫发作控制结果显示EngelⅠ级24例,Ⅱ级8例,Ⅲ级3例,Ⅳ级0例。其中有12例病人术后2年逐渐停用抗癫痫药物。结论联合应用VEEG、MRI及EcoG能准确确定致痫灶,提高颞叶癫痫手术疗效。手术方式选择及显微理念的应用,能有效减少术后并发症的发生,避免出现永久性神经功能缺失。
Objective To summarize and analyze the preoperative localization, surgical methods and experience of intractable temporal lobe epilepsy. Methods A retrospective analysis of 35 patients with temporal lobe epilepsy treated with anterior temporal lobe + hippocampus amygdala from June 2009 to June 2011, including 32 cases of hippocampal cirrhosis confirmed by preoperative MRI and postoperative pathology, In all cases, the temporal cortex and the ipsilateral hippocampus and amygdala were excised under cortical electrode monitoring. All the patients were treated with antiepileptic drugs after operation. The patients were followed up for 1-3 years. Results Among the 35 follow-up cases, the results of seizure control showed 24 cases of EngelⅠ, 8 cases of Ⅱ, 3 cases of Ⅲ and 0 cases of Ⅳ. Twelve of these patients stopped using antiepileptic drugs gradually after 2 years. Conclusions The combined application of VEEG, MRI and EcoG can accurately identify epileptogenic lesions and improve the therapeutic effect of temporal lobe epilepsy. Surgical options and the application of microscopic concepts can effectively reduce the incidence of postoperative complications, to avoid permanent loss of nerve function.