神经导航手术治疗难治性颞叶癫痫(附56例报告)  

Neuronavigator-assisted surgery for refractory temporal lobe epilepsy (report of 56 cases)

作　　者：刘岳[1] 吴高贤[2] 戢翰升[1] 唐振刚[1] 汪纯[1] 任妮丽[1] 李彩丽[1] 

机构地区：[1]湖北医药学院附属十堰市人民医院神经外科,十堰442000 [2]广州军区武汉总医院保健科,武汉430070

出　　处：《中国临床神经外科杂志》2013年第3期152-153,157,共3页Chinese Journal of Clinical Neurosurgery

基　　金：十堰市科技局科研资助项目(2010st21)

摘　　要：目的 探讨神经导航结合皮层脑电监测在难治性颞叶癫痫(TLE)术中的应用价值,以及难治性TLE的可能发病原因。方法 回顾性分析行前颞叶及海马切除术治疗的56例难治性TLE患者的临床资料。患者均采用神经导航手术,术前行视频脑电图(V-EEG)和MRI定位癫痫灶,术中行颞叶皮层电极描记(ECoG)异常脑电区。结果 本组术前癫痫灶定位率为100%。术后随访2～3年,按Engle标准评定疗效:Ⅰ级50例,Ⅱ级4例,Ⅲ级1例,Ⅳ级1例;本组患者治愈率达到89.29%(50/56),总有效率为98.21%(55/56)。无手术并发症及死亡病例。病理学确诊为海马硬化46例,占82.14%(46/56);伴双重病理现象35例,占62.50%(35/56)。结论 难治性TLE多因脑组织结构异常所致;应用神经导航和ECoG监测可提高手术治愈率,减少术后并发症。Objectives To investigate the value of neuronavigation and electrocorticogram （ECoG） to the surgery for the refractory temporal lobe epilepsy and to analyze the cause of the refractory temporal lobe epilepsy. Methods The clinical data of 56 patients with refractory temporal lobe epilepsy, who underwent anterior temporal lobectomy and hippocampectomy, were analyzed retrospctively. Results The following-up from 2 to 3 years showed that the cure rate was 89.29% （50/56） and the total effective rate was 98.21% （55/ 56）. There was no operative complication and no patients died in all the patients. The pathological examination showed that 46 （82.14%） had hippoeampal sclerosis and the dual pathology was detected in 35 patients （62.50%）. Conclusions The refractory temporal lobe epilepsy is caused by brain structural abnormalities in most of the patients. The cure rate may be enhanced and the operative complications may be decreased by the appliaction of neuronavigator and EcoG to surgery in the patients refractory temporal lobe epilepsy.

关 键 词：难治性颞叶癫痫 神经导航 皮层电极描记 皮层脑电图 显微手术 

分 类 号：R742.1[医药卫生—神经病学与精神病学] R651.11[医药卫生—临床医学]