27例学龄前难治性颞叶癫痫患儿临床报道  

Clinical analysis of 27 preschoolers with refractory temporal lobe epilepsy

作　　者：郭效东 路小奇 王振华 许鹏 刘明辉 郝文明 杨新超 李俊龙 李经纶 姚安会 王本瀚 Guo Xiaodong;Lu Xiaoqi;Wang Zhenhua;Xu Peng;Liu Minghui;Hao Wenming;Yang Xinchao;Li Junlong;Li Jinglun;Yao Anhui;Wang Benhan(Hospital of Joint Logistic Support Force of People's Liberation Army,Zhengzhou 450042,China)

机构地区：[1]解放军联勤保障部队第九八八医院全军神经外科中心,郑州450042

出　　处：《中华神经医学杂志》2021年第1期65-70,共6页Chinese Journal of Neuromedicine

基　　金：河南省医学科技攻关计划项目(LHGJ20190868)。

摘　　要：目的探讨学龄前难治性颞叶癫痫患儿影像学、电生理特点及手术方法和疗效。方法回顾性分析解放军联勤保障部队第九八八医院神经外科中心自2014年6月至2019年1月行手术治疗的27例学龄前难治性颞叶癫痫患儿资料,术前评估结合临床发作表现,MRI、磁共振波谱分析(MRS)、正电子发射断层扫描(PET-CT)等影像资料,以及发作间期和发作期视频脑电图(VEEG)资料;术中应用皮层脑电图(ECoG)与深部电极监测定位异常放电区域,指导手术切除致痫灶范围。术后采用Engel分级评估疗效。结果27例患儿均有典型颞叶癫痫临床表现,MRI发现一侧颞叶及海马异常信号影,发作间期及发作期VEEG提示异常放电起始于一侧额颞部。术中ECoG及深部电极监测均发现颞叶明显持续或阵发性尖波、棘波、棘慢复合波等癫痫样放电。27例患儿均采用标准前颞叶+病灶切除+周边异常放电颞叶皮质扩大切除术,其中2例患儿切除部分岛叶长回及额盖皮质热灼处理。随访6个月,EngelⅠ级患儿22例,EngelⅡ级患儿3例,EngelⅢ级患儿2例。结论早期手术、术中ECoG与深部电极联合监测下适度扩大切除范围是改善学龄前难治性颞叶癫痫患儿手术疗效的关键因素。Objective To investigate the imaging and electrophysiological characteristics,surgical methods and efficacies of preschoolers with refractory temporal lobe epilepsy.Methods A retrospective data study was conducted on 27 patients with refractory temporal lobe epilepsy accepted surgical treatment in our hospital from June 2014 to January 2019.By combined with clinical manifestations,preoperative epileptogenic zones were evaluated by imaging data,such as MR imaging,MR spectroscopy and positron emission tomography-CT,and interictal and ictal video-electroencephalogram(VEEG)data.During the surgery,cortical electroencephalography(ECoG)and deep electrode monitoring were used to monitor and locate the abnormal discharge areas to guide the surgical excision of epileptic zone.Engel grading was used to evaluate the efficacy after surgery.Results All children had typical clinical manifestations of temporal lobe epilepsy;abnormal signal images were found in one side of the temporal lobe and the hippocampus in MR imaging;epileptic discharges were originated from one side frontotemporal region in interictal and ictal VEEG.Obviously persistent or paroxysmal spike waves,spike waves and slow spikes and spike composite waves were intraoperatively discovered by ECoG and depth electrode electroencephalography in the temporal lobe.All patients accepted standard anterior temporal lobectomy+lesion resection+peripheral abnormal discharge resection of the temporal lobe cortex;partial insular lobe was excised and frontal cortex was performed low power thermal coagulation in two patients.Follow-up was performed for 6 months;Engel grading I was reported in 22 patients(81.5%),Engel grading II in 3 patients(11.1%),and Engel grading III in 2 patients(7.4%).Conclusion Early surgery and moderate extension of resection under intraoperative ECoG and deep electrode monitoring are the key factors to improve the surgical efficacy of preschoolers with refractory temporal lobe epilepsy.

关 键 词：颞叶癫痫 儿童 前颞叶切除术 皮层脑电图 

分 类 号：R742.1[医药卫生—神经病学与精神病学]