海马硬化型颞叶癫痫的外科治疗——附42例报告
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摘要
目的探讨海马硬化型颞叶癫痫的临床特点及手术治疗的疗效。方法收集2012年1月—2018年12月于武汉脑科医院行前颞叶切除术治疗的42例海马硬化型颞叶癫痫患者,其中男30例,女12例,年龄9～60岁,病程3～10年,临床表现为复杂部分性发作18例,部分性发作继发全身性发作4例,全身强直-阵挛性发作20例。结合患者的临床表现、核磁共振检查和视频脑电图(VEEG)监测结果,对所有患者行前颞叶切除术(包括大部分海马和杏仁核)。结果所有患者术后病理检查均证实海马硬化的诊断,术后随访1年以上,38例癫痫无发作,4例术后较术前显著改善。结论对于存在海马硬化的颞叶癫痫患者,如果VEEG监测提示同侧颞叶痫样放电,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),且术后疗效也较满意。
Objective To explore the clinical features and surgical treatment effects of the temporal lobe epilepsy with hippocampal sclerosis. Methods Forty two patients diagnosed as temporal lobe epilepsy with hippocampal sclerosis and underwent protemporal lobectomy in Wuhan Brain Hospital from Jan. 2012 to Dec. 2018 were collected, which included 30 males and 12 females, with the age between 9 to 60 years. Their disease duration ranged from 3 to 10 years.The clinical manifestations showed complex partial seizure in 18 cases, partial-secondary –generalized seizure in 4 cases,and generalized tonic-clonic seizure in 20 cases. Based on their results of clinical manifestations, combined with MRI and VEEG results, all the patients underwent anterior temporal lobectomy(including the most parts of the hippocampus and amydala). Results The postoperative pathology confirmed the diagnosis of hippocampal sclerosis. The follow-up of more than 1 year showed seizure-free in 38 cases, and significant improvement in 4 cases. Conclusions To the patients of temporal lobe epilepsy with hippocampal sclerosis, anterior temporal lobectomy should be performed(including the most parts of the hippocampus and amydala) if the VEEG monitoring results show that there are epileptic discharges in the ipsilateral temporal lobe. And the postoperative curative result is satisfactory.
Objective To explore the clinical features and surgical treatment effects of the temporal lobe epilepsy with hippocampal sclerosis. Methods Forty two patients diagnosed as temporal lobe epilepsy with hippocampal sclerosis and underwent protemporal lobectomy in Wuhan Brain Hospital from Jan. 2012 to Dec. 2018 were collected, which included 30 males and 12 females, with the age between 9 to 60 years. Their disease duration ranged from 3 to 10 years.The clinical manifestations showed complex partial seizure in 18 cases, partial-secondary –generalized seizure in 4 cases,and generalized tonic-clonic seizure in 20 cases. Based on their results of clinical manifestations, combined with MRI and VEEG results, all the patients underwent anterior temporal lobectomy(including the most parts of the hippocampus and amydala). Results The postoperative pathology confirmed the diagnosis of hippocampal sclerosis. The follow-up of more than 1 year showed seizure-free in 38 cases, and significant improvement in 4 cases. Conclusions To the patients of temporal lobe epilepsy with hippocampal sclerosis, anterior temporal lobectomy should be performed(including the most parts of the hippocampus and amydala) if the VEEG monitoring results show that there are epileptic discharges in the ipsilateral temporal lobe. And the postoperative curative result is satisfactory.
引文
1Fernando C, William HT, Benjamin HB, et al. Neuroimaging of epilepsy. Handb Clin Neurol, 2016, 136:985-1014.
2Boling WW. Surgical considerations of intractable mesial temporal lobe epilepsy. Brain Sci, 2018, 8(2):22-35.
3Thom M. Review:hippocampal sclerosis in epilepsy:a neuropathology review. Neuropathol Appl Neurobiol, 2014, 40(5):520-543.
4Englot DJ, Chang EF. Rates and predictors of seizure freedom in resective epilepsy surgery:an update. Neurosurg Rev, 2014, 37(3):389-405.
5谭启富,李龄,吴承远.癫痫外科学(第二版).北京:人民卫生出版社, 2012, 102-105.
6姜保东.海马硬化的MRI研究进展.医学影像学杂志, 2008, 18(9):1076-1080.
7Briellmann RS, Pell GS, Wellard RM, et al. MR imaging of epilepsy:state of the art at 1.5T and potential of 3T. Epileptic Disord, 2003,5(1):3-20.
8Briellmann RS, Kalnins RM, Berkovie SF, et al. Hippocampal pathology in refractory temporal lobe epilepsy T2-weighted signal change reflects dentate gliosis. Neurology, 2002, 58(2):265-271.
9Ana MG, Juan FO. Diagnosis of mesial temporal sclerosis:sensitivity, specificity and predictive values of the quantitative analysis of magnetic resonance imaging. J Neuroradiol, 2018, 31(1):50-59.
10Mueller SG, Laxer KD, Cashdollar N, et a1. Spectroscopic evidence of hippocam--pal abnormalities in neocortical epilepsy. Eur J Neurol, 2006, 13(2):256-260.
11Susanne GM, Kenneth DL, Joyce S, et al. Spectroscopic metabolic abnormalities in mTLE with and without MRI evidence for mesial temporal sclerosis using hippocampal short-TE MRSI. Epilepsia,2003, 44(7):977-980.
12高翔,江澄川,洪震,等.海马硬化与颞叶癫痫的关系.上海医科大学学报, 2000, 27(2):115-116.
13段宝奇,傅传经,高觉民,等.探讨手术对海马硬化型颞叶癫痫的疗效.中国继续医学教育, 2017, 8(23):95-97.
14钱海燕,马羽,许尚臣,等.前颞叶切除术与选择性海马杏仁核切除术治疗海马硬化性颞叶内侧癫痫疗效比较.山东医药, 2011,51(46):84-85.
15 董艳芳,张春阳,梅小龙,等.海马硬化型癫痫的手术治疗.中华神经外科杂志, 2012, 28(1):82-83.
2Boling WW. Surgical considerations of intractable mesial temporal lobe epilepsy. Brain Sci, 2018, 8(2):22-35.
3Thom M. Review:hippocampal sclerosis in epilepsy:a neuropathology review. Neuropathol Appl Neurobiol, 2014, 40(5):520-543.
4Englot DJ, Chang EF. Rates and predictors of seizure freedom in resective epilepsy surgery:an update. Neurosurg Rev, 2014, 37(3):389-405.
5谭启富,李龄,吴承远.癫痫外科学(第二版).北京:人民卫生出版社, 2012, 102-105.
6姜保东.海马硬化的MRI研究进展.医学影像学杂志, 2008, 18(9):1076-1080.
7Briellmann RS, Pell GS, Wellard RM, et al. MR imaging of epilepsy:state of the art at 1.5T and potential of 3T. Epileptic Disord, 2003,5(1):3-20.
8Briellmann RS, Kalnins RM, Berkovie SF, et al. Hippocampal pathology in refractory temporal lobe epilepsy T2-weighted signal change reflects dentate gliosis. Neurology, 2002, 58(2):265-271.
9Ana MG, Juan FO. Diagnosis of mesial temporal sclerosis:sensitivity, specificity and predictive values of the quantitative analysis of magnetic resonance imaging. J Neuroradiol, 2018, 31(1):50-59.
10Mueller SG, Laxer KD, Cashdollar N, et a1. Spectroscopic evidence of hippocam--pal abnormalities in neocortical epilepsy. Eur J Neurol, 2006, 13(2):256-260.
11Susanne GM, Kenneth DL, Joyce S, et al. Spectroscopic metabolic abnormalities in mTLE with and without MRI evidence for mesial temporal sclerosis using hippocampal short-TE MRSI. Epilepsia,2003, 44(7):977-980.
12高翔,江澄川,洪震,等.海马硬化与颞叶癫痫的关系.上海医科大学学报, 2000, 27(2):115-116.
13段宝奇,傅传经,高觉民,等.探讨手术对海马硬化型颞叶癫痫的疗效.中国继续医学教育, 2017, 8(23):95-97.
14钱海燕,马羽,许尚臣,等.前颞叶切除术与选择性海马杏仁核切除术治疗海马硬化性颞叶内侧癫痫疗效比较.山东医药, 2011,51(46):84-85.
15 董艳芳,张春阳,梅小龙,等.海马硬化型癫痫的手术治疗.中华神经外科杂志, 2012, 28(1):82-83.