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目的探讨多处软膜下横纤维切断术(MST)联合其他术式对难治性颞叶癫(ITLE)的疗效。方法92例ITLE患者,术前均行脑电图(EEG)、头颅CT及磁共振(MR I)检查,其中34例行正电子发射断层扫描(PET)、54例行单电子发射断层扫描(SPECT)检查。经定侧定位后行手术治疗。92例患者中41例行病灶切除加致灶切除加MST,33例行标准前颞叶切除加MST,18例行标准前颞叶切除加胼胝体切开加MST。手术在皮层电极或深部电极监测下进行,并在显微镜下操作。结果满意(癫发作停止)53例(57.6%),其中有25例已停服抗药;显著改善(发作频率减少75%以上)21例(22.8%);良好(发作减少50%~75%)9例(9.8%);效差或无效(发作频率减少不足50%)9例(9.8%)。本组总有效率为90.2%,显效率为80.4%。结论MST联合病灶或(和)致灶切除治疗ITLE,既能取得较好的疗效又能保留更多的脑功能。
Objective To investigate the effect of multiple sub-transverse transection (MST) combined with other surgical procedures on refractory temporal lobe epilepsy (ITLE). Methods Ninety-two ITLE patients underwent preoperative EEG, CT and MRI examinations. Among them, 34 patients underwent positron emission tomography (PET) and 54 patients underwent single electron tomography SPECT) check. After positioning the side after surgery. Forty-one patients underwent focal resection combined with mastectomy plus MST in 41 patients. Thirty-three patients underwent standard anterior temporal lobectomy plus MST. Eighteen patients underwent standard anterior temporal lobectomy plus corpus callosum incision plus MST. Surgery was performed under cortical or deep electrode monitoring and was operated under a microscope. The results were satisfactory (epileptic seizures stopped) 53 cases (57.6%), of which 25 cases had stopped taking anti-tuberculosis drugs; significantly improved (seizure frequency reduced by 75% or more) in 21 cases (22.8% 9 cases (9.8%); 9 cases (9.8%) were ineffective or ineffective (less than 50% reduction in seizure frequency). The total effective rate was 90.2%, markedly effective rate was 80.4%. Conclusions The combined treatment of MST or (and) resection of ITLE can not only achieve better curative effect but also retain more brain function.