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目的研究颞叶新皮层癫痫外科治疗的临床相关问题。方法42例病人术前均经128导视频EEG及MRI检查,MRI阴性者进一步行SPECT检查;对于术前无创检查难以确定致痫灶者行硬膜下电极埋藏纪录;术中利用ECoG进一步明确致痫灶的范围后进行个体化治疗。结果①本组资料中,术前MRI的病理灶定位与128导视频EEG的致痫灶定侧高度一致(P<0.05);②MRI阳性的35例中有25例致痫灶位于病灶附近,MRI阴性7例者的SPECT与术中ECoG结果完全一致;③参照Engel标准,本组病例平均随访3.6±1.1年,总有效率为88.10%,其中Ⅰ级占71.43%,Ⅱ级占16.67%;④致痫灶处理的手术方式与预后密切相关(P<0.05)。结论①颞叶新皮层癫痫的术前定位应综合考虑方可决定手术方案;②明确致痫灶仅限于颞叶新皮层时,手术不必涉及到颞叶内侧面结构,以防增加病人的致残率。
Objective To study the clinical problems related to surgical treatment of temporal lobe neocortex epilepsy. Methods Forty-two patients underwent preoperative EEG and MRI examinations with 128-channel video preoperatively and MRI-negative patients undergoing further SPECT examinations. It was difficult to determine the burial history of epidural electrodes in preoperative noninvasive examination. ECoG was used to further clarify The range of epileptic foci for individualized treatment. Results ①In this group, the pathological location of preoperative MRI was the same as that of epileptic side of 128-video EEG (P <0.05); ② Among 25 MRI-positive cases, 25 cases had epileptic foci located in the vicinity of the lesion, MRI According to Engel’s standard, the average follow-up of this group was 3.6 ± 1.1 years, the total effective rate was 88.10%, of which Ⅰ grade accounted for 71.43% and Ⅱ grade accounted for 16.67%; ④ Epileptic foci of surgical treatment and prognosis are closely related (P <0.05). Conclusions ① The preoperative localization of temporal lobe neocortex epilepsy should be considered in combination with the determination of the operative plan. ② When the definite epileptogenic zone is limited to the neocortex of the temporal lobe, it is not necessary to involve the medial temporal structure of the temporal lobe in order to prevent the disability of the patient rate.