颞叶占位性病变伴癫痫患者的脑电图特征及手术疗效  

Electrophysiological characteristics and surgical outcome of epilepsy patients with temporal mass lesions

作　　者：李焕发[1] 王超[1] 孟强[1] 董珊[1] 井晓荣[1] 马炜[1] 高国栋[1] 张华[1] 

机构地区：[1]第四军医大学唐都医院神经外科,西安710038

出　　处：《中国临床神经外科杂志》2014年第5期257-259,共3页Chinese Journal of Clinical Neurosurgery

摘　　要：目的探讨颞叶占位性病变伴癫痫患者的脑电图癫痫样放电的分布特征及手术疗效。方法回顾性分析31例颞叶占位性病变伴癫痫患者术前脑电图及术后随访资料，其中囊性占位7例，海绵状血管瘤6例，胶质瘤16例，其他病变2例；均行病变完全切除术，大部分包括前颞叶及内侧结构切除。结果术前癫痫发作间期脑电图癫痫样波分布与病变位置关系：仅出现在病变侧颞叶12例（38．7％），超出病变侧颞叶14例（45．2％），完全不在病变侧颞叶3例（9．7％）；脑电图正常2例（6．4％）。监测中出现癫痫发作的17例患者中，病变侧颞叶起源12例（70．6％），双侧颞叶起源1例（5．9％），对侧颞叶起源1例（5．9％），不确定起源位置3例（17．6％）。术后随访12～56个月，平均28个月，按Engel分级，Ⅰ级25例，Ⅱ级2例，Ⅲ级2例；失随访2例。结论颞叶占位性病变伴癫痫患者发作间期癫痫样波不仅仅局限于同侧颞叶，发作期脑电与病变有很好的相关性，该类患者应尽早手术切除治疗，可取得很好的疗效。Objective To explore the electrophysiological characteristics and surgical outcome of epilepsy patients with temporal mass lesions. Methods The clinical data of 31 epilepsy patients with temporal mass lesions, of whom 7 had cystic lesions, 6 cavernous angiomas, 16 gliomas and 2 gliosis accompanied with focal hemorrhage were analyzed retrospectively, including preoperative electroencephalogram （EEG） and postoperative follow-up data and so on. Results The analysis of relationship between preoperative interictal epileptiform discharges （IDEs） distribution and regions of the lesions showed that IDEs were exclusively over the lesional temporal lobes in 12 patients （38.7%）, IDEs were not limited to lesional temporal lobes in 14 （45.2%）, IEDs were not over the lesional temporal lobes at all in 3 （9.7%） and the interictal EEG were normal in 2 （6.4%）. The seizures were recorded during the monitoring in 17 patients, of whom, 12 （70.6%） had epileptic seizures exclusively over the lesional temporal lobes, 1 （5.9%） had seizures originated from bitemporal lobes independently, I （5.9%） had seizures originated only from contralateral temporal lobe and 3 （17.6%） had seizures originated from the undecided cerebral regions. All the patients underwent total removal of the lesions, and most patients underwent lesional anterior temporal lobectomy and amygdalohippocampectomy. According to Engel class, control effect on the epileptic seizures reached Engel class Ⅰ in 25, class Ⅱ in 2 and class Ⅲ in 2 of 29 patients who were followed up from 12 to 56 months （mean, 28 months）. Conclusions IEDs was not only limited over the lesional temporal lobes in the patients with temporal mass lesions. The ictal EEG origin is related to the lesional region. The control effect of surgery which is performed as early as possible on the epileptic seizures is good in the epilepsy patients with temporal mass lesions.

关 键 词：癫痫 颞叶占位性病变 脑电图 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]