神经导航引导海马病灶切除联合皮质热灼治疗顽固性颞叶内侧癫痫  

Treatment of intractable medial temporal lobe epilepsy by navigation system guided hippocampal lesion resection combining with cortex thermocoagulation

作　　者：姜晓峰[1] 傅先明[1] 喻廉[2] 凌至培[1] 汪业汉[1] 殷晓梅[2] 钱若兵[1] 牛朝诗[1] 付古月[3] 

机构地区：[1]安徽省立医院神经外科,230001 [2]安徽省立体定向神经外科研究所电生理室 [3]安徽省立体定向神经外科研究所手术室

出　　处：《立体定向和功能性神经外科杂志》2005年第1期10-12,共3页Chinese Journal of Stereotactic and Functional Neurosurgery

基　　金：安徽省科学事业费项目 ;安徽省临床医学重点学科技术进步专项课题 (编号 :2 0 0 4Z0 0 7)

摘　　要：目的　探讨神经导航引导、皮质电极监测下对海马病灶进行致痫灶切除 ,辅助以皮质痫灶横纤维热灼术治疗顽固性颞叶内侧癫痫的临床价值。方法　通过对 16例海马病灶的顽固性癫痫的病人 ,术前进行 2 4小时脑电图描记定位致痫灶 ,手术前进行磁共振扫描 ,数据输入神经导航系统 ,手术当天进行导航注册配准 ,术中进行颞叶皮质电极描记 ,并在导航棒引导下找寻海马病灶 ,完整切除并辅以皮质热灼治疗致痫灶。结果　术后 0 .5～ 3年内随访 ,按Engel癫痫疗效分级 :发作完全消失 11例 (6 8.8% ) ,明显改善 4例 (2 5 % ) ,改善 1例 (6 .2 % )。 结论　神经导航有助于海马病灶的准确找寻与切除 ,在皮质电极监测下 ,辅助皮质热灼是治疗顽固性颞叶内侧癫痫的一种有效、安全的方法。Objective To assess the usefulness of intractable medial temporal lobe epilepsy treated by navigation-guided hippocampal lesion resection combining with cortex thermocoagulation on the surround cortexes by monitoring of electocorticalgram.Methods 16 cases of intractable temporal lobe epilepsy with hippocampal lesion were examined by 24 hours monitoring EEG to locate the epileptogenic lesion.The preoperative MRI scans were transferred into the navigation workstation.With landmarks registration and matching before operation,the hippocampal lesion could be defined and were resected total.Using electocorticalgram combining with cortex thermocoagulation,epileptogenic focus could be treated.Results 16 cases were followed up 0.5～3 years,according to Engel standard of curative effect,seizure disappeared totally in 11 cases(68.8%),marked improvement in 4 cases(25%),improvement in 1 case(6.2%).Conclusion Neuronavigation will provide accurately guidance for localizing the hippocampal lesion and resection.By monitoring of electocorticalgram,lesionectomy combining with cortex thermocoagulation on the surround cortexes is an effective and safe means to treat intractable medial temporal lobe epilepsy.

关 键 词：神经导航 海马 热灼 皮质电极 顽固性颞叶癫痫 

分 类 号：R742.1[医药卫生—神经病学与精神病学]