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1、伴海马硬化的颞叶癫痫患者的临床特点及手术治疗中国临床神经外科杂志2010年5月第15卷第5期ChinJClinNeurosurg,May2010,Vo1.15,No.5—261一论着.伴海马硬化的颞叶癫痫患者的临床特点及手术治疗王焕明王建一胡飞【摘要】目的探讨颞叶癫痫海马硬化的临床特点及手术治疗的效果.方法伴海马硬化的颞叶癫痫患者18例,其中男10例,女8例;年龄12～37岁,病程3～10年.癫痫复杂部分性发作lO例,部分性发作继发全身性发作2例,全身强直一痉挛性发作6例.结合患者的临床表现,MRI检查和视频脑电图(V—EEG)监测结果,对这18例患者行前颞叶切除术(包括大部
2、分海马和杏仁核).结果所有患者术中皮层和深部电极脑电图均发现颞叶皮层海马,杏仁核有异常放电,术后病理检查均证实海马硬化的诊断.术后l8例患者均出现发热,但经过抗炎,腰椎穿刺及支持治疗后渐好转.术后1年以上的随访发现16例癫痫发作完全消失,2例术后较术前显着改善,仅偶有癫痫发作,但均长期服用抗癫痫药物.结论对于颞叶癫痫伴有海马硬化的患者,如果同时脑电图又发现有同侧颞叶痫样放电,则可以考虑行该侧前颞叶切除术(包括大部分海马和杏仁核),若手术切除彻底,其术后疗效也较满意.【关键词】颞叶癫痫;海马硬化;手术【文章编号】1009—153X(2010)05—0261—03【文献标志码】A
3、【中国图书资料分类号】R651.1l;R742.1ClinicalfeaturesandsurgicaltreatmentoftemporallobeepilepsyinthepatientswithhippocampalsclerosisWANGHuan-ming,WANGJian-yi,HUFei.DepartmentofNeurosurgery,WuhanBrainHospitalandChanghangGeneralHospital,Wuhan43001~China【Abstract】ObjectiveToexploretheclinicalfeaturesoftem
4、porallobeepilepsyinthepatientswithhippoeampalsclerosisandcurativeeffectsofsurgeryonit.MethodsOf18patientswithtemporallobeepilepsyaccompaniedwithhippocampalsclerosis,10weremaleand8female,andtheiragesrangedfrom12to37years.Theirillnessdurationrangedfrom3tO10years.Theclinicalmanifestationsinclu
5、dedcomplexpartialseizurein10cases,generalizedseizuresecondarytopartialseizurein2,andgeneralizedtonoclonicseizurein6.MRI,electroencephalogram(EEG)andvideoEEG(V-EEG)wereperformedinallthepatients.Allthepatientsunderwentanteriortemporallobectomy(includingremovalofthemostpartsofthehippocampusand
6、amygdala)undertheguidanceofcorticalEEGanddeepEEG.ResultsThehippocampalsclerosiswasconfirmedbythepostoperativepathologicalexamination.Thefollowing—upformorethan1yearshowedthattheseizuredisappearedin16cases,andwassignificantlyalleviatedin2.ConclusionsTheanteriortemporallobectomy(includingremo
7、valofthemostpartsofthehippocampusandamygdala)shouldbeperformedinthepatientswithtemporallobeepilepsyaccompaniedwithhippocampalsclerosis,iftheEEGshowsthatthereareepilepticdischargesintheipsilateraltemporallobe.Thecurativeeffectofanteriortemporallobectomy(i
