立体定向脑电图引导下3D交叉射频热凝毁损术治疗药物难治性内侧颞叶癫痫伴海马硬化的有效性及安全性  

Efficacy and safety of stereoelectroencephalography-guided 3D radiofrequency thermocoagulation for the treatment of drug-resistant medial temporal lobe epilepsy with hippocampal sclerosis

作　　者：金磊 支迪暄 杨彦枫 陈思畅 王天任 陆地 单永治[1] Jin Lei;Zhi Dixuan;Yang Yanfeng;Chen Sichang;Wang Tianren;Lu Di;Shan Yongzhi(Department of Neurosurgery,Xuanwu Hospital,Clinical Research Center for Epilepsy,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院神经外科、首都医科大学癫痫临床诊疗与研究中心,北京100053

出　　处：《中华医学杂志》2025年第11期827-833,共7页National Medical Journal of China

基　　金：首都卫生发展科研专项(首发2022-2-2011)。

摘　　要：目的评估立体定向脑电图(SEEG)引导下的3D交叉射频热凝毁损术(RF-TC)治疗药物难治性内侧颞叶癫痫伴海马硬化(mTLE-HS)的有效性与安全性。方法该研究为随机对照试验,前瞻性纳入2019年8月至2022年10月在首都医科大学宣武医院招募的药物难治性mTLE-HS患者,使用可变区组随机方法分配接受前颞叶切除术(ATL)或RF-TC治疗。所有患者均在术前和手术干预1年后进行了评估。比较两组患者术后癫痫发作结果、视野缺损情况以及手术相关并发症。结果共纳入38例患者,男19例,女19例,年龄(28.3±6.9)岁。ATL组20例,RF-TC组18例,两组患者年龄[(28.5±5.7)岁比(28.2±8.1)岁,P=0.848]、性别(7/20比12/18,P=0.103)比较,差异无统计学意义。术后1年随访时,ATL组和RF-TC组癫痫发作结果达到EngelⅠ类的占比差异无统计学意义(17/20比13/18,P=0.438)。ATL组出现视野缺损的比例高于RF-TC组(15/20比3/18,P<0.010)。两组术后均未出现严重不良事件。结论SEEG引导下的3D交叉RF-TC癫痫控制效果与传统手术相当,在视野保护方面效果优于传统手术。Objective:To evaluate the efficacy and safety of stereotactic electroencephalography(SEEG)-guided 3D radiofrequency thermocoagulation(RF-TC)in the treatment of drug-resistant mesial temporal lobe epilepsy with hippocampal sclerosis(mTLE-HS).Methods:This study was a randomized controlled trial.The patients with drug-resistant mTLE-HS recruited from Xuanwu Hospital,Capital Medical University between August 2019 and October 2022 were prospectively enrolled.The patients were randomly assigned to receive either anterior temporal lobectomy(ATL)or RF-TC treatment using a variable block randomization method.All patients were assessed both preoperatively and 1 year postoperatively.The postoperative outcomes in terms of epileptic seizure results,visual field defects,and surgery-related complications were compared between the two groups.Results:A total of 38 patients were included,19 males and 19 females,with an average age of(28.3±6.9)years.There were 20 cases in the ATL group and 18 cases in the RF-TC group.There was no statistically significant difference in age[(28.5±5.7)vs(28.2±8.1),P=0.848]or gender distribution(7/20 vs 12/18,P=0.103)between the both groups.At the 1-year follow-up post-surgery,there was no statistically significant difference in the proportion of patients achieving Engel ClassⅠfor epileptic seizure results between the ATL group and the RF-TC group(17/20 vs 13/18,P=0.438).The proportion of patients in the ATL group who developed visual field defects was higher than that in the RF-TC group(15/20 vs 3/18,P<0.010).No severe adverse events were observed in both groups.Conclusion:The epilepsy control efficacy of SEEG-guided 3D RF-TC is comparable to that of traditional surgery,while offering superior outcomes in visual field preservation.

关 键 词：癫痫 内侧颞叶癫痫 海马硬化 立体定向脑电图 射频热凝术 视野缺损 随机对照研究 

分 类 号：R74[医药卫生—神经病学与精神病学]