引用本文:[点击复制]
[点击复制]
【打印本页】 【在线阅读全文】【下载PDF全文】 查看/发表评论下载PDF阅读器关闭

←前一篇|后一篇→

过刊浏览    高级检索

本文已被:浏览 204次   下载 401  
颞叶癫痫的致痫灶定位评估和外科治疗:附27例报告
孟祥红尚宝祥付萌萌冯刚魏明怡李瑞麒陶蔚陈富勇
0
()
摘要:
目的 探讨颞叶癫痫的致痫灶定位评估手段和外科治疗的疗效和安全性。方法 回顾性 分析27 例2016 年8 月至2018 年11 月在深圳市第二人民医院和深圳大学总医院开展难治性颞叶癫痫患 者的临床资料。致痫灶评估检查包括:详尽的发作症状学,癫痫序列颅脑MRI,发作间期正电子发射断 层扫描(PET),长程视频脑电图监测,癫痫神经心理评估资料和立体定向脑电图监测(SEEG),多学科团 队讨论完成致痫灶和功能区定位后完成外科手术。结果 13例患者经Ⅰ期评估后直接行手术切除,14 例 经SEEG 置入后手术切除。所有患者随访时间为6~34 个月,平均为(19.93±9.00)个月。手术疗效采用 ILAE 分级标准,ILAE Ⅰ级22 例(81.48%),ILAE Ⅱ级1 例(3.70%),ILAE Ⅲ级2 例(7.41%),ILAE Ⅳ级2 例 (7.41%);SEEG 置入组的ILAE Ⅰ级比例(12/14)高于无SEEG 置入组(10/13),MRI 阳性组的ILAE Ⅰ级比 例(16/19)高于MRI阴性组(6/8),但两组比较差异无统计学意义。1例行SEEG置入术后颅内出血,1 例前颞 叶切除术后出现迟发性颅内血肿,2例患者出现一过性动眼神经热损伤,1例头皮切口愈合不良,4 例术后 颅内感染,无脑脊液漏,无视野缺损等并发症。结论 外科手术治疗难治性颞叶癫痫是安全有效的,详 尽的术前致痫灶定位评估和SEEG 置入可以提高手术疗效。
关键词:  癫痫, 颞叶  立体定向脑电图  癫痫外科  疗效  并发症
DOI:10.3969/j.issn.1009-6574.2019.06.005
基金项目:深圳市科技创新委员会基础研究学科布局项目(JCYJ20160428164548896,JCYJ20170412111316339); 深圳大学总医院科技人才助推计划(SUGH-301)
Presurgical evaluation and surgical treatment for the patients with refractory temporal lobe epilepsy:A report of 27 cases
Meng Xianghong, Shang Baoxiang, Fu Mengmeng, Feng Gang, Wei Mingyi, Li Ruiqi, Tao Wei, Chen Fuyong
()
Abstract:
Objective To investigate the current procedure of presurgical evaluation and the efficacy and safety of surgical treatment for temporal lobe epilepsy. Methods The clinical data of 27 patients with refractory temporal lobe epilepsy who had operation from August in 2016 to November in 2018 in Shenzhen Second People's Hospital and Shenzhen University General Hospital were analyzed retrospectively. Multiple analysis was used in the presurgical evaluation, including seizure semiology, epileptic sequence of brain MRI (1 mm per slice), interictal Positron Emission Tomography( PET), Video EEG monitoring, epilepsy battery of clinical neuropsychological testing and stereotactic EEG monitoring( SEEG). A multi-disciplinary team was involved in the localization and evaluation of epilepsy foci and functional cortex, as well as making the operation plan. Results A total of 13 patients underwent primary resection after noninvasive assessment, and 14 patients underwent surgical resection after SEEG implantation. All patients were followed up for 6-34 months with an average follow-up time of( 19.93±9.00) months. Surgical efficacy was assessed according to ILAE class criteria. Totally, there were 22 cases of ILAE grade Ⅰ( 81.48%), 1 case of ILAE grade Ⅱ( 3.70%), 2 cases of ILAE gradeⅢ( 7.41%), and 2 cases of ILAE grade Ⅳ( 7.41%). The SEEG implantation group had higher ratio of ILAE grade Ⅰ comparing to no SEEG implantation group( 12/14 vs 10/13), the MRI positive group had higher ratio of ILAE gradeⅠ than the MRI negative group( 16/19 vs 6/8). However, there was no statistically significant difference between the two groups. For complications, one patient had intracranial hemorrhage after SEEG electrode implantation, one patient had delayed intracranial hematoma after anterior temporal lobe resection, two patients had transient oculomotor nerve injury, one patient had poor scalp incision, four patients had post-operation infection. There were no cases of cerebrospinal fluid leakage or visual field damage or any other complications. Conclusions With more detailed presurgical evaluation and SEEG implantation, the outcome of surgical treatment for refractory temporal lobe epilepsy is becoming more effective.
Key words:  Epilepsy  Temporal lobe  Stereoelectroencephalography  Epilepsy surgery  Outcome  Complications

用微信扫一扫

用微信扫一扫