经颞下回-侧脑室入路选择性海马杏仁核切除术治疗内侧颞叶癫痫  

Selective amygdalohippocampectomy via the inferior temporal gyrus approach for treatment of mesial temporal lobe epilepsy

作　　者：杨朋范[1] 魏梁锋[1] 赵琳[1] 梅珍[1] 黄茂[1] 王如密[1] 

机构地区：[1]南京军区福州总医院神经外科癫痫中心,福州350025

出　　处：《中华神经医学杂志》2009年第7期682-684,共3页Chinese Journal of Neuromedicine

基　　金：福建省科技厅对外合作项目（2006I0024）

摘　　要：目的探讨经颞下回-侧脑室入路选择性海马杏仁核切除术治疗内侧颞叶癫痫的手术方法、疗效及并发症。方法对确诊为药物难治性内侧颞叶癫痫的62例患者，经颞部锁孔开颅，切除中前段颞下回，进入颞角前外侧区，选择性切除海马杏仁核及海马旁回等内侧颞叶结构。结果62例患者术后随访至少24～80个月，无严重手术并发症；Engel癫痫疗效分级：Ⅰ级45例（72．6％），Ⅱ级12例（19．4％），Ⅲ级5例（8．0％）。结论经颞下回-侧脑室入路选择性海马杏仁核切除术是治疗内侧颞叶癫痫的有效方法，其手术创伤小，可妥善保护语言区和视放射，安全性高。Objective To explore the surgical skills, therapeutic effects and complications of selective amygdalohippocampectomy via the inferior temporal gyrus approach for treatment of mesial temporal lobe epilepsy （MTLE）. Methods Sixty-two patients with medically intractable MTLE underwent selective amygdalohippocampectomy. Temporal keyhole craniotomy was performed, and the mid-anterior segment of the inferior temporal gyrus was resected to access the anterolateral floor of the temporal horn. The mesial temporal structures such as the amygdale and the parahippocampal gyrus were selectively resected. Results All the patients were followed up for at least 2 years （range 24-80 months） after the surgery. Obvious improvement of the neuropsychological function was achieved in these patients after the operation, without serious surgical complications. Forty-five patients （72.6%） had Engel＇s Class Ⅰ , 12 （19.4%） had class Ⅱ, and 5 （8.0%） had classⅢ outcomes after the operation. Conclusion The inferior temporal gyms approach allows minimally invasive amygdalohippocampectomy that preserves both the optic radiation and the language area, and can be especially effective in patients with epileptic lesions limited to the mid-anterior temporal lobe.

关 键 词：杏仁核海马切除术 颞下回 颞叶癫痫 

分 类 号：R686[医药卫生—骨科学]