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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 the temporal lobe medial epilepsy (MTLE) caused by the lesions of the hippocampus, especially the tumors. Methods Twenty-one patients with MTLE were surgically treated. EEG monitoring and MR MR were performed preoperatively. Postoperative resection of the hippocampus was performed. Results The main clinical manifestations of complex partial seizures; scalp EEG monitoring see spikes. Preoperative MR imaging showed long T2 signal of hippocampus, 10 cases of full volume, enlarged temporal horn, long T2 signal of hippocampus, 8 cases of hippocampus volume reduction, long T1 long T2 signal of hippocampus, Normal in 2 cases. Postoperative pathology confirmed 11 cases of hippocampal sclerosis, 6 cases of astrocytoma, 1 case of ganglioneuroma, 1 case of embryonic dysplastic neuroepithelioma, 1 case of atypical hyperplasia and 1 case of radiation necrosis. Follow-up to 18 patients, 16 of them without epileptic seizures. Statistical analysis showed that the imaging changes of hippocampal tumors and hippocampal sclerosis were statistically significant. Conclusions For patients with temporal lobe medial epilepsy, if the hippocampus has a long T2 signal on MRI and the volume of the hippocampus is full on the contralateral side, the possibility of a tumor in the hippocampus should be considered and positive surgery should be taken from the treatment strategy.