双侧颞叶癫的立体定向外科治疗  

Stereotactic treatment for bilateral temporal lobe epilepsy

作　　者：赵全军[1] 田增民[1] 吴朝辉[1] 林鸿[1] 尹丰[1] 郝秋星[1] 王红[1] 肖霞[1] 王福莉[1] 李红玉[1] 于雪[1] 

机构地区：[1]海军总医院神经外科测,北京100048

出　　处：《中国微侵袭神经外科杂志》2011年第11期493-495,共3页Chinese Journal of Minimally Invasive Neurosurgery

摘　　要：目的探讨双侧海马-杏仁核复合体毁损术治疗双侧颞叶癫的疗效。方法回顾性分析5例双侧颞叶癫病人的临床资料,复杂部分性发作中的自动症1例,部分性继发全身性癫4例。均行深部电极引导下机器人辅助定位双侧海马-杏仁核复合体毁损术。结果随访1～2.5年,按Engel分级:Ⅰ级2例;Ⅱ、Ⅲ、Ⅳ级各1例。术后MRI显示:双侧海马-杏仁核复合体区无严重的结构性破坏。智商、心算速度、符号数字配对、划消、数字记忆广度、指扣试验等神经心理学检查指标手术前后差异均无统计学意义(P>0.05)。结论双侧颞叶癫无法实施切除性手术,而立体定向外科治疗可减少癫发作,且并未造成严重认知功能障碍,是一种值得尝试的外科治疗手段。Objective To explore therapeutic effect of bilateral amygdalohippocampotomy for the treatment of bilateral temporal lobe epilepsy. Methods Clinical data of 5 patients with bilateral temporal lobe epilepsy, including automatism of complex partial seizures in 1 case and partial seizures secondary to generalized epilepsy in 4, were analyzed retrospectively. Amygdalohippocampotomy was performed under the deep-electrode-guidance with robotic assistance in all the patients. Results The patients were followed-up for 1 to 2.5 years, 2 patients were assessed as class I and 3 as class Ⅱ, Ⅲ, Ⅳ respectively according to Engel＇s classification. Postoperatively MRI showed no severe structural damage in the bilateral amygdalohippocampal areas complex. There were no significant difference in the neuropsychological examinations such as intelligence quotient, mental arithmetic, symbol-digit pairing, distinguish cancellation, digital memory span and finger-knock test between before and after operations （P〉0.05）. Conclusions The resection is unsuitable for bilateral temporal lobe epilepsy, while stereotactic surgery can reduce seizure and can not result in severe cognitive dysfimction, thus being worthy to be attemoted for the treatment of bilateral temooral lobe epilepsy.

关 键 词：颠痫 立体定位技术 神经心理学测验 

分 类 号：R742.1[医药卫生—神经病学与精神病学] R651.19[医药卫生—临床医学]