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目的探讨颞叶占位性病变伴癫痫患者手术治疗的疗效,分析多种致痫灶定位技术的联合应用对手术疗效的影响。方法回顾性分析31例颞叶占位性病变伴癫痫患者术前脑电图及术后随访资料,其中囊性占位7例,海绵状血管瘤6例,胶质瘤16例,其他病变2例;应用MRI、视频脑电图、脑磁图行致痫灶定位,术中应用皮质脑电图再次精确致痫灶范围后行前颞叶联合海马切除术,术后随访评估疗效。结果长程VEEG监测中,20例患者均有惯常发作和发作间期痫样放电,14例(14/20)患者发作间期痫样放电位于单侧颞叶及海马区,其中合并同侧额区放电5例。6例(6/20)患者发作间期放电位于双侧颞叶,其中合并单侧额区放电2例。8例(8/20)起源于左侧颞叶及海马区,12例(12/20)起源于右侧。MEG检查20例患者发作间歇期皆有痫样放电,检出率为100%,17例(17/20)患者单侧颞叶放电,其中合并同侧额区放电8例;3例(3/20)患者双颞放电。术后随访12~24个月:16例患者Ⅰ级,3例Ⅱ级,1例Ⅲ级,手术有效率100%,效果良好率95%。结论颞叶占位性病变伴癫痫患者的手术治疗疗效好,多种致痫灶定位技术的联合应用可提高手术疗效并有效减少术后并发症。
Objective To investigate the effect of surgical treatment of temporal lobe space-occupying lesions with epilepsy and to analyze the effect of the combined application of multiple epileptogenic lesions on surgical outcomes. Methods A retrospective analysis of 31 cases of temporal lobe space-occupying lesions with epilepsy before surgery and EEG data and postoperative follow-up information, including cystic lesions in 7 cases, cavernous hemangioma in 6 cases, glioma in 16 cases, other lesions 2 Cases; using MRI, video electroencephalogram, magnetoencephalography line of seizure mapping, intraoperative cortex electroencephalogram again accurate range of epileptogenic lesions after anterior temporal lobe combined with resection of the hippocampus, postoperative follow-up evaluation of the effect. Results In the long-term VEEG monitoring, all 20 patients had the usual onset and interictal epileptiform discharges. In 14 patients (14/20), epileptiform discharges were located in the unilateral temporal lobe and hippocampus, and the ipsilateral frontal area Discharge in 5 cases. In 6 patients (6/20), the interictal discharge was located in the bilateral temporal lobe, with 2 cases of unilateral scoliosis discharge. Eight cases (8/20) originated in the left temporal lobe and hippocampus, and 12 cases (12/20) originated in the right side. MEG examination of 20 patients with intermittent episodes of epileptiform discharge, the detection rate was 100%, 17 cases (17/20) patients with unilateral temporal lobe discharge, including ipsilateral frontal discharge in 8 cases; 3 cases (3 / 20) Patients with double temporal discharge. The patients were followed up for 12-24 months: 16 cases were grade Ⅰ, 3 cases were grade Ⅱ and 1 case was grade Ⅲ. The operative efficiency was 100% and the effective rate was 95%. Conclusions The surgical treatment of temporal lobe occupying lesions with epilepsy is effective. The combined application of multiple techniques of locating epileptic foci can improve the curative effect and reduce the postoperative complications effectively.