摘要
目的研究颞叶新皮层癫痫外科治疗的临床相关问题。方法42例病人术前均经128导视频EEG及MRI检查,MRI阴性者进一步行SPECT检查;对于术前无创检查难以确定致痫灶者行硬膜下电极埋藏纪录;术中利用ECoG进一步明确致痫灶的范围后进行个体化治疗。结果①本组资料中,术前MRI的病理灶定位与128导视频EEG的致痫灶定侧高度一致(P<0.05);②MRI阳性的35例中有25例致痫灶位于病灶附近,MRI阴性7例者的SPECT与术中ECoG结果完全一致;③参照Engel标准,本组病例平均随访3.6±1.1年,总有效率为88.10%,其中Ⅰ级占71.43%,Ⅱ级占16.67%;④致痫灶处理的手术方式与预后密切相关(P<0.05)。结论①颞叶新皮层癫痫的术前定位应综合考虑方可决定手术方案;②明确致痫灶仅限于颞叶新皮层时,手术不必涉及到颞叶内侧面结构,以防增加病人的致残率。
Objective The goal of this paper was to evaluate pre-surgical location of epileptogenitic zone suffering drug-resistant neocortical temporal lobe epilepsy, as well as post-surgical outcomes and factors affecting seizure outcomes in these patients. Methods and Motheds 42 cases to this study with strick selection was examined with 128 channels Vedio EEG and MR1 . The patients had examined with SPECT when MRI examined was negative. When epileptogenitic zone of the patients was difficult to identify by noninvasive examination, the subdural strip electrodes would be used. According to presurgical data and ECoG results during operation, each patient had been made with different operative methods. Results ①There were significant confidence between pathological lesion by MRI and epileptogenitic zone by EEG（P〈0. 05）;②The epileptogenitic zone of 25 cases in 35 cases which MRI examination was positive localized near the pathological lesion. Of 7 cases whose MRI were negative, the results of SPECT were consistent with ECoG; ③According to Engle＇s ceritisia, all patients have fellow up 3. 6±1. 1 years,the total effective rate was 88. 10% which I class was 71. 43% and II class 16. 67%;④There were significaut corperation between the operative methods of epileptic focus and the outcome of pateints. Conclusion ①Operative planing of the neocortical temple lobe epilepsy must be consideration of the presurgery date. ②When the epileptogenitic zone is only localized at the neo- cortical temporal lobe,the surgery don＇t make for mesial temporal lobe.
出处
《立体定向和功能性神经外科杂志》
2008年第5期275-279,共5页
Chinese Journal of Stereotactic and Functional Neurosurgery
关键词
颞叶新皮层
颞叶癫痫
致痫灶
癫痫外科
Neocortical temporal lobe
Temporal lobe epilepsy
Epileptic focus
epilepsy surgery
