海马病变的特点及手术治疗  

Clinical characteristics and operative effect of hippocampus lesions

作　　者：蒋星军[1] 杨治权[1] 袁贤瑞[1] 伍军[1] 袁盾[1] 李学军[1] 侯永宏[1] 

机构地区：[1]中南大学湘雅医院神经外科,长沙410008

出　　处：《中南大学学报（医学版）》2010年第12期1282-1287,共6页Journal of Central South University ：Medical Science

摘　　要：目的:总结海马病变的临床特点及手术治疗效果。方法:对2005年8月至2010年4月在我科手术治疗的44例海马病变的临床特点进行回顾性分析,了解其手术结果和并发症。结果:44例病人中以癫痫为首发症状者有40例,占90.9%。病理结果为:胶质瘤18例,海绵状血管瘤9例,海马硬化12例,海马皮质发育不良2例,非典型性增生、外伤性疤痕及软化灶各1例。其中13例行前内颞叶切除术,31例经侧裂行选择性杏仁核海马及海马病变切除术。癫痫病人随访37例,平均随访时间15.7月,其中I级27例(73.0%),II级5例(13.5%),III级4例(10.8%),IV级1例(2.7%)。围手术期无死亡,偏瘫1例,明显视野缺损2例。胶质瘤病人术后随访期间远处复发死亡2例。结论:海马病变以癫痫为主要临床表现,手术治疗效果满意,并发症少。Objective To study the clinical characteristics and operative effect of hippocampus lesions. Methods We retrospectively analyzed the clinical characteristics and operative outcome of 44 patients with hippocampus lesions between August 2005 and April 2010. Results Seizure attack was the initial symptom among 40 of the 44 patients. Pathological examinations revealed 18 gliomas, 9 cavernous malformations, 12 hippocampus sclerosis, 2 focal cortical dysplasia, 1 atypical hyperplasia, 1 injury glial scar, and 1 encephalomalacia. Thirteen patients received anterior medial temporal lobectomy and the other 31 received lesionectomy or selective amygdalohippocampectomy via transsylvian approach. An average of 15.7 month follow-up was accomplished in 37 patients. Postoperative epileptic outcomes were evaluated according to Engel classification： Grade I 73.0%（27/37）, Grade II 13.5%（5/37）, Grade III 10.8%（4/37） and Grade IV 2.7%（1/37） .No perioperative death occurred. One patient experienced hemiplegia but recovered 8 months after the operation. Noticeable postoperative visual field deficit was left in 2 patients. Two patients with glioma died of remote tumor recurrence during follow-up. Conclusion Seizure attack is a major complaint of hippocampus lesions. Satisfactory seizure and tumor control may be achieved through anterior medial temporal lobectomy or selective amygdalohippocampectomy with lesionectomy.

关 键 词：海马 经侧裂入路 前颞叶切除术 

分 类 号：R651.1[医药卫生—外科学]