摘要
目的总结分析枕叶癫痫患者手术中联合选择性海马切除的手术治疗效果和经验。方法回顾性分析2003年1月至2006年12月在我科接受手术治疗的20例向颞叶内侧传导的枕叶癫痫病例，统计患者的发病、检查及手术治疗情况，并介绍相关手术体会。17例（85％）为部分性发作继发强直-痉挛性发作为主，9例有颞叶先兆或口咽自动症，PET检查中9例有颞叶的代谢异常，MRI及MRS共发现有海马异常13例；脑电图确定癫痫灶位于枕叶外侧皮层8例，内侧皮层6例，枕颞交界区6例，发作期脑电图均显示明显向颞叶传导。手术均行枕叶致痫灶切除和经颞底海马结构切除术。结果癫痫发作Engle分级示：I级16例，Ⅱ级2例，Ⅲ级2例。出现视野损害3例；推理智商无明显变化15例，下降4例，改善1例。结论向颞叶传导为主的枕叶癫痫常可以有颞叶的先兆或自动症，并有影像学的异常，手术联合枕叶致痫灶切除和经颞底海马结构切除术，手术效果好。
Objective o analyze the surgical outcome and experience of the combination of cortex resection and hippocampotomy for surgical treatment of intractable occipital epilepsy. Methods 20 surgical cases of occipital epilepsy with conducting to hippocampus were studied retrospectively. The patient＇s general clinical data, seizure features, surgical outcomes and surgical experiences were studied. There were 17 cases （85%） under partial seizures and secondary general tonic-clonic attack, 9 patients with temporal aures or automasim, 9 cases with temporal abnormal metabolizing in PET imaging and 13 cases with abnormal in MRI or MRS imaging in hippocampus. Epileptogenics was located in lateral occipital lobe in 8 cases （40%）, temporo-occipital lobe in 6 cases （ 30% ） and mesial occipital lobe in 6 cases. All patients were performed the operation of combination of occipital cortex resection and hippocampotomy. Results The surgical results included 16 Engle I cases, 2 Ⅱ cases and 2 Ⅲ grade cases. Conclusion Intractable occipital epilepsy with conducting to hippocampus always has temporal aures or automasim and abnormal image of temporal lobe. The operation of the combination of occipital cortex resection with hippocampotomy could achieve good surgical outcome.
出处
《中华神经外科杂志》
CSCD
北大核心
2009年第4期324-326,共3页
Chinese Journal of Neurosurgery
关键词
癫痫外科
枕叶癫痫
海马切除术
临床特点
预后
Epilepsy surgery
Hippocampotomy
Intractable occipital lobe epilepsy
Clinic feature
Outcome
