颞叶内侧占位病灶所致癫痫的显微外科治疗  

Microsurgical treatment of epilepsy induced by the medial temporal lobe lesion

作　　者：徐德明[1] 徐纪文[2] 刘凤强[1] 钱佳栋[1] 芮奕峰[1] 

机构地区：[1]浙江省嘉兴市第一医院神经外科,314000 [2]上海第二医科大学附属仁济医院神经外科癫痫中心

出　　处：《中国医师进修杂志（外科版）》2009年第12期23-25,共3页Chinese Journal of Postgraduates of Medicine

摘　　要：目的观察病灶切除联合海马杏仁核切除术治疗颞叶内侧占位病灶所致癫痫的手术效果。方法回顾性分析颞叶内侧占位病灶所致癫痫且术中深部电极探查出海马异常放电的18例患者，采用改良翼点切口开颅经颞中回皮层入路行病灶切除联合海马杏仁核切除治疗，18例患者均取得了占位病灶的肉眼全切，采用Engel分级量表评价癫痫控制效果。结果所有病例均获得随访，平均2．8年。术后Engel分级I级13例，Ⅱ级4例，Ⅲ级1例，Ⅳ级0例，2例出现对侧1／4象限盲；3例出现近期记忆功能较术前下降，无手术死亡及其他持久并发症。结论病灶切除联合海马杏仁核切除术治疗病侧海马异常放电的颞叶内侧占位病灶所致癫痫，并发症少，安全有效。Objective To evaluate the surgical effect of the surgical removal of both medial temporal lobe lesion and hippocampus amygdala for treating epilepsy. Methods Retrospectively analyzed 18 cases of epilepsy induced by the medial temporal lobe lesion and their hippocampal epileptic discharge was recorded by the deep electrode. Removed both medial temporal lobe lesion and hippocampus amygdala through medial temporal gyrus by modified pterional approach. The lesion had been totally removed in all of these 18 cases in naked eye. Evaluated the effect of surgery for epilepsy by Engel grading scale. Results These eases were followed up for average 2.8 years. Engel I for 13 cases, Engel lI for 4 eases, Engel Ill for 1 cases, Engel IV for none after operation. But there were lateral 1/4 quadrantanopsia in 2 eases, recent memory decreasing in 3 eases and none of death or any other complication. Conclusion Surgical removal of both medial temporal lobe lesion and hippocampus amygdala is a safe and effective method for treating epilepsy with less complication.

关 键 词：癫痫 颞叶占位 显微外科手术 

分 类 号：R739.42[医药卫生—肿瘤] R733.2[医药卫生—临床医学]