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目的探讨ECoG及D-EEG定位显微外科手术治疗60例颞叶难治性癫痫的临床经验。方法术前将临床表现、脑电图、神经影像学检查进行综合分析定位,取额颞骨大瓣开颅,术中皮层脑电(ECoG)及深部脑电(D-EEG)监测,在显微手术下先切除颞前叶,后切除颞叶内侧结构(杏仁核、海马头),术后继续服用抗癫痫药物治疗,2年方可考虑逐渐减量或停药。结果无死亡病例和明显并发症,随访0.5～3年,38例(63.3%)发作完全消失,17例(28%)发作减少75%,3例(5%)发作减少50%以上,效差2例(3%),有效率达91.3%。结论应用ECoG及D-EEG定位显微手术治疗颞叶癫痫可以明显减少并发症,提高临床疗效。
Objective To investigate the clinical experience of ECoG and D-EEG microsurgery in the treatment of 60 patients with temporal lobe intractable epilepsy. Methods The clinical manifestations, electroencephalogram and neuroimaging were analyzed before and after operation. The large temporal cochlear craniotomy, ECoG and D-EEG monitoring were performed. Surgical removal of the anterior temporal lobe, resection of the temporal lobe medial structures (amygdala, hippocampus), postoperative antiepileptic drugs continue to take 2 years to consider gradual reduction or withdrawal. Results No deaths and obvious complications were observed. During the follow-up of 0.5 to 3 years, 38 cases (63.3%) had complete disappearance of seizures, 17 (28%) seizures decreased by 75% and 3 (5%) seizures decreased by 50% 2 cases (3%), the effective rate of 91.3%. Conclusion The application of ECoG and D-EEG microsurgical treatment of temporal lobe epilepsy can significantly reduce complications and improve clinical efficacy.