伽玛刀治疗颞叶内侧癫痫疗效分析(附26例临床分析)  

Treatment of Gamma Knife radiosurgery for drug-resistant mesial temporal lobe epilepsy

作　　者：周文静[1] 胡泽勇[1] 刘晓华[1] 赵涤凡[1] 匡山[1] 夏廷毅[1] 张纪[2] 

机构地区：[1]空军总医院放疗科伽玛刀中心,北京100036 [2]解放军总医院神经外科

出　　处：《立体定向和功能性神经外科杂志》2005年第6期346-349,共4页Chinese Journal of Stereotactic and Functional Neurosurgery

摘　　要：目的探讨伽玛刀治疗颞叶内侧癫痫的方法与疗效。方法2000年9月至2005年1月应用伽玛刀治疗颞叶内侧癫痫患者共26例,病程平均8年(4～42年)。治疗范围包括杏仁核,海马及部分海马旁回,50%等剂量曲线边缘剂量平均19Gy(15～20Gy)。结果随访0.7～5.03年,平均1.13年。26例患者中有10例发作完全消失,发作频率减少在50%以上的患者16例(62%),在随访时间大于1.5年的9例患者中有6例发作完全消失,发作频率减少在50%以上的患者7例(77.8%)。所有患者中21例复查了核磁共振(MRI),有14例在术后12个月前后出现局部水肿及血脑屏障破坏。全部病人未见头痛、记忆力下降、视束损伤等并发症。结论初步结果显示伽玛刀治疗颞叶内侧癫痫安全、有效,最终疗效评估仍需大量病例长期随访确定。Objective To review the approach and efficacy in the field of drug-resistant mesial temporal lobe epilepsy （MTLE） after stereotatic rotating gamma knife radiosurgery. Methods Between Sep 2000 and Jan 2005,26 patients （20 male and 6 female） with a mean age of 23 years （13- 55） who presented with drug-resistant mesial temporal lobe epilepsy （MTLE） were selected. Doses given at marginal 50% isodoses ranged from 15 to 20 Gy （mean 19 Gy） covered the amygdala, hippocampal head and body, and parahippocampal gyrus, doses of the optic nerves less than 10Gy. Results A following-up of mean 1.13 years（0.7--5.03） was now available for all of 26 patients. 10 patients were seizure free, and 6 were improved（seizure frequency reduction more than 50 % ）. 21 patients of 26 were underwent magnetic resonance imaging（MRI） after treatment,and edema in the irradiated area were observed 14 patients after 12 months. Conclusion We reported 26 patients demonstrating that gamma knife radiosurgery can be a safe and effective treatment for drug-resistant mesial temporal lobe epilepsy. Although the benefits of comfort and reduced invasivity can be clearly perceived, larger series and long-term follow up are still required in order to evaluate the future of this approach.

关 键 词：颞叶内侧癫痫 难治性癫痫 伽玛刀 放射外科 

分 类 号：R742.1[医药卫生—神经病学与精神病学]