颅脑外伤后迟发性顽固性癫痫的病理与手术方式探讨  

Histopathological features and optimal operative procedure for patients with late intractable epilepsy after traumatic brain injuries

作　　者：高进喜[1] 魏梁锋[1] 杨朋范[1] 郑兆聪[1] 刘峥[1] 王守森[1] 

机构地区：[1]南京军区福州总医院神经外科,福州350025

出　　处：《解放军医学杂志》2011年第7期773-775,共3页Medical Journal of Chinese People's Liberation Army

基　　金：福建省青年人才基金(2005J073)

摘　　要：目的探讨颅脑外伤后迟发性顽固性癫痫的发病基础及最佳手术方式。方法取21例因颅脑外伤后迟发性顽固性癫痫接受手术治疗切除的颞叶新鲜标本,详细描述皮质分层结构,观察细胞的形态、数量和分布,分析海马组织的结构及其他病变组织的病理特点。结果颅脑外伤后脑叶软化灶和瘢痕增生是外伤性癫痫发生的病理基础,前颞叶切除标本最常见的病理改变是海马硬化合并颞叶皮质细胞结构不良（15例,占71.4%）。术后随访6个月2年,疗效评价显示21例患者中疗效Ⅰ级14例、Ⅱ级4例、Ⅲ级3例;疗效满意66.7%（14/21）,效果良好19.0%（4/21）,疗效差14.3%（3/21）。结论颅脑外伤后迟发性顽固性癫痫最常见的颞叶病理改变是海马硬化和皮质细胞结构不良,这两种改变常伴随出现。目前对于该类患者仍推荐采用病理灶切除＋标准前颞叶切除术治疗。Objective To investigate the pathological features and optimal operation of the patients with late intractable epilepsy after traumatic brain injuries（TBI）.Methods Fresh specimens of temporal lobe were obtained during operation from 21 patients with late intractable epilepsy after TBI to investigate the cortical structure,cellular morphology,number and distribution,and analyze the structure of hippocampus and pathological features of other tissues.Results The pathological features of brain tissue in epilepsy after TBI were encephalomalacia and hypertrophic scar,and the marked pathological changes in resected temporal lobe were hippocampal sclerosis and dysplasia of temporal cortex cells（seen in 15 of 21 cases）.The therapeutic effects were assessed by a 6-month to 2-year follow-up,and satisfactory effects were obtained in 14 out of 21 patients（66.7%）（Grade Ⅰ）,favorable effects were seen in 4 cases（19.0%）（Grade Ⅱ）,and poor outcomes were seen in 3 cases（14.3%）（Grade Ⅲ）.Conclusions Hippocampal sclerosis and construction abnormalities of temporal lobe cortex are the most common pathological features,and they always co-exist in patients with late intractable epilepsy.The resection of pathological lesion combined with standard anterior temporal lobectomy is currently the recommended operation choice for late intractable epilepsy after TBI.

关 键 词：颅脑损伤 癫痫 海马硬化 前颞叶切除术 

分 类 号：R651.15[医药卫生—外科学]