摘要
目的探索海马病变特别是肿瘤引起颞叶内侧型癫痫(MTLE)的临床特征。方法手术治疗MTLE患者21例,术前行脑电监测、头MR I检查,术后对切除海马进行病理检查。结果临床表现主要为复杂部分性发作;头皮脑电监测多数见棘波。术前MR I片影像学表现为海马长T2信号、体积较饱满10例,颞角扩大、海马长T2信号、海马体积缩小8例,海马长T1长T2信号、有明显占位表现1例,正常2例。术后病理证实海马硬化11例,星形细胞瘤6例,神经节细胞瘤1例,胚胎发育不良性神经上皮样肿瘤1例,非典型增生1例,放射坏死1例。随访到18位患者,其中16位无癫痫发作。统计学分析表明海马肿瘤与海马硬化的影像学改变差异有统计学意义。结论对于颞叶内侧型癫痫患者,如果海马在MR I上表现长T2信号,体积较对侧海马饱满,应该考虑海马肿瘤可能,从治疗策略上应该积极手术。
Objective To explore the clinical features of hippocampal lesions. Methods the clinical data of 21 patients with hippocampal lesions, 15 males and 6 females, aged 19 （8 -42）, with a duration of mesial temporal lobe epilepsy （ MTLE ）, underwent resection of the anterior temporal lobe, amygdaloid nucleus, and hippocampus. The resected hippocampal tissues were examined pathologically. Before the operation 24 - hour EEG and MRI scan were performed. The patients were followed up for 1 - 2 years. Results The clinical manifestations included complex partial seizure （11 cases）, absence seizure （5 cases） , tonic -clonic seizure （4 cases） , and simple partial seizure （1 ease）. EEG showed spike waves in 18 patients. MRI scan showed full hippoeampus and long T2 signal in 10 cases, enlarged temporal horn, hyperintense signal in T2, and decreased volume of hippoeampus in 8 cases, long T1 and T2 signals and obvious space- occupying lesion in hippoeampus in one case, and normal images in 2 cases. Pathological examination revealed sclerosis of hippocampus in 11 cases, astrocytoma in 6 cases, paraganglioma in 1 case, embryonic tumor of neuroeplthelial tissue in 1 case, atypical hyperplasia in 1 case, and radiation necrosis in 1 case. Sixteen of the eighteen followed - up patients remained seizure - free. Statistical analysis demonstrated significant difference in MRI between hippocampal tumor and hippocampal sclerosis. Conclusion MTLE patients with T2 signal and r hippocampus large than that of the contralateral side should be considered as with hippocampal tumor and as indication of operation.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2005年第46期3286-3288,共3页
National Medical Journal of China
关键词
癫痫
颞叶
海马
肿瘤
硬化
Epilepsy, temporal lobe
Hippoeampus
Neoplasms
Sclerosis
