难治性颞叶内侧癫痫的手术疗效及其影响因素分析（英文）  

Seizure outcome after surgery for medically intractable mesial temporal lobe epilepsy and its predictors

作　　者：黄玲玥[1] 杜浩[1] 向露[1] 刘琴[1] 吕丽辉[1] 陈璐璐[1] 徐国政[1] HUANG Lingyue;DU Hao;XIANG Lu;LIU Qin;LV Lihui;CHEN Lulu;XU Guozheng(Department of Neurosurgery,Wuhan General Hospital of PLA,Wuhan 430070,Chin)

机构地区：[1]中国人民解放军武汉总医院神经外科,湖北武汉430070

出　　处：《南方医科大学学报》2018年第7期773-779,共7页Journal of Southern Medical University

摘　　要：目的分析手术治疗难治性颞叶内侧癫痫(MTLE)的疗效,并对手术疗效的相关因素进行评价。方法回顾性分析2011年9月~2013年10月于我科行前颞叶切除术(ATL)或选择性海马杏仁核切除术(SAH)治疗的30例难治性MTLE患者术后的癫痫控制情况,参考Engel分级标准对手术疗效进行评价。收集本研究组中病例的临床资料,分析各因素与手术疗效的相关性。结果术前评估确诊为难治性MTLE的患者共34例,其中有4例由于颅内脑电监测结果显示癫痫发作为双侧颞叶内侧起源,故未采取致痫灶切除术。另外30例均接受手术治疗,术后随访3.5~5.5年,其中23例(76.7%)手术疗效满意,7例(23.3%)疗效不佳。疗效不佳组中6例癫痫发作表现为除典型颞叶内侧癫痫自动症及先兆外,还常继发全面性发作,1例患者伴有智力减退。统计分析提示无特殊病史者,手术预后较好;ALT与SAH(经颞上沟入路和经外侧裂入路)的手术预后无统计学差异。结论难治性MTLE经手术治疗可取得满意疗效,无特殊病史者手术预后可能更佳。经颞上沟入路的SAH在难治性MTLE手术治疗中可能更具有优势。Objective To evaluate seizure outcome in patients receiving surgery for chronic medically intractable mesial temporal lobe epilepsy（MTLE） and analyze its possible predictors. Methods This retrospective study was conducted in patients with chronic medically intractable MTLE undergoing anterior temporal lobectomy（ATL） or selective amygdalohippocampectomy（SAH） in our department between September, 2011 and October, 2013. The patients were followed up for 3.5 to 5.5 years, during which the seizure outcome was evaluated according to Engel＇s classification. The clinical data were collected from the patients to identify the possible predictors that affected the outcome of the patients using Mann-Whitney U test or Kruskal-Wallis test. Results A total of 34 patients were included in this study with a definite diagnosis of chronic medically intractable MTLE after preoperative noninvasive and invasive evaluation. In 4 of these patients, invasive EEG monitoring confirmed that epileptic discharges originated from the bilateral mesial temporal lobe, and hence surgical resection of the epileptogenic zone was not performed. The other 30 patients underwent surgical resection of the epileptogenic zone with ALT or SAH, and favorable outcomes were achieved in 23（76.7%） of the patients.Of the 7（23.3%） patients with poor outcomes, 6 patients presented with typical automatism and aura with frequent secondary generalized tonic-clonic seizure, and the other one patient exhibited impaired intelligence. Statistical analysis suggested that the patients without a special disease history（trauma, febrile seizure, or encephalitis） tended to have a more favorable seizure outcome.Conclusions Surgical interventions can achieve good therapeutic effect on chronic medically intractable MTLE, and patients without a special disease history may have more favorable outcomes after the surgery. SAH via the superior temporal sulcus approach can be a better surgical option for intractable MTLE.

关 键 词：颞叶内侧癫痫 前颞叶切除术 选择性海马杏仁核切除术 手术疗效 预测因素 

分 类 号：R651.11[医药卫生—外科学]