侧裂入路选择性海马、杏仁核切除术治疗颞叶癫癎  

Selective amygdalohippocampectomy via trans-sylvian approach for temporal lobe epilepsy

作　　者：樊丰势[1] 王政刚[1] 张旭东[1] 张卫宁[1] 程建业[1] 黄英雄[2] 李建衡[2] 陈峰[2] 

机构地区：[1]中国人民解放军白求恩国际和平医院神经外科,河北石家庄050080 [2]中国人民解放军第467医院神经外科,河北石家庄050081

出　　处：《中国微侵袭神经外科杂志》2005年第2期55-57,共3页Chinese Journal of Minimally Invasive Neurosurgery

摘　　要：目的总结对颞叶癫病人行侧裂径路选择性海马、杏仁核显微切除术的经验。方法对28例顽固性颞叶癫病人进行常规脑电图(蝶骨电极)、视频脑电图实时监测、MRI、单光子发射断层显像(SPECT)、正电子发射断层成像(PET)等检查,确定颞叶癫灶。行翼点开颅,经右侧手术17例,左侧11例,行颞叶径路选择性海马、杏仁核显微切除术。结果术后发作完全停止20例(71.4%);症状显著改善,偶有发作3例(10.7%);好转3例(10.7%);无效2例。结论根据临床表现及综合性辅助检查确定颞叶癫,行侧裂径路选择性海马、杏仁核显微切除术,可以取得满意疗效;但要求解剖清晰,显微外科技术熟练,避免意外损伤脉络膜前动脉和大脑中动脉。Objective To review our experience with transsylvian selective amygdalohippocampectomy in the patients with temporal lobe epilepsy (TLE). Methods Twenty-eight patients with medically intractable temporal epilepsy were recruited in the study and the epileptic foci were determined by such examinations as conventional EEG (including sphenoid electrode), Video-EEG, MRI, single photon emission computed tomography (SPECT), and position emission tomography (PET). The right pterional approach was adopted in 17 cases and the left approach in 11 cases. Results Epilepsy was completely relieved following the surgery in 20 cases (71.4%), and significantly improved with occasional onsets in 3 cases (10.7%). The symptoms were ameliorated in 3 cases (10.7%), which remained unchanged in 2 cases. Conclusion The diagnosis of TLE can be established on the basis of clinical manifestations and complementary examinations, and transsylvian selective amygdalohippocampectomy may yield good result, but a thorough understanding of the neurosurgical anatomy of the involved structures and proficient operative skills are essential for preventing damages to the anterior choroidal artery and the middle cerebral artery.

关 键 词：癫痫 颞叶 侧裂入路 海马 杏仁核 

分 类 号：R651[医药卫生—外科学]