海马区病变继发癫痫的显微外科治疗  

Microsurgery for the treatment of epilepsy secondary to hippocampal lesions

作　　者：王军[1] 王运杰[1] 欧绍武[1] 仇波[1] 刑德广 吴鹏飞[1] 杜江[1] 

机构地区：[1]中国医科大学附属第一医院神经外科,辽宁沈阳110001

出　　处：《中华神经外科疾病研究杂志》2015年第4期345-349,共5页Chinese Journal of Neurosurgical Disease Research

摘　　要：目的探讨海马区病变继发癫痫的显微外科治疗方式及效果。方法对48例海马区病变继发癫痫患者的临床资料、病理学结果、手术方式及手术效果进行回顾性分析。结果术后病理诊断胶质瘤23例,血管畸形15例,海马硬化10例。行选择性病变及周围受侵组织切除术者23例,标准颞前叶、病灶和受侵组织及颞叶内侧结构切除术者25例。随访患者42例,平均随访23.5个月,术后6个月时癫痫缓解率,Engel分级1级34例(81%),2级7例(16.6%),3级1例(2.4%),两种术式间癫痫的缓解率EngelⅠ级分别为80%(16/20)及81.8%(18/22),无统计学差异。结论显微外科手术是治疗海马区病变继发癫痫的首选治疗方式,可根据病变的具体性质选择不同的手术入路及手术方式。Objective The different surgical approaches and outcomes of microsurgery for the treatment of epilepsy secondary to hippocampal lesions are discussed.Methods A retrospective analysis of the clinical data, pathological results, surgical methods and outcomes was performed in 48 epileptic cases secondary to hippocampal lesions.Results The pathological results confirmed 23 cases of gliomas, 15 cases of vascular malformations, and 10 cases of hippocampus sclerosis.Selective resection of lesions and surrounding tissues was performed in 23 patients, while standard anterior temporal lobectomy and amygdalohippocampectomy with resection of lesions and surrounding tissues were performed in 25 patients, respectively.Forty-two patients were followed up and the mean duration of follow-up was 23.5 months.Thirty-four （81%） of 42 patients were in Engel 1 at 6 months＇follow-up, 7（16.7%） in Engel 2, and 1 （2.3%） in Engel 3.The rates of epilepsy freedom （Engel 1） in the two groups were 80%（16/20） and 81.8% （18/22）, respectively, and there was no statistical difference.Conclusion Microsurgery should be considered as the optimal treatment for the epilepsy secondary to hippocampal lesions.The surgical approaches and methods can be determined by the specific properties of different lesions.

关 键 词：海马 癫痫 显微外科 

分 类 号：R605[医药卫生—外科学]