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目的探讨伽玛刀对颞叶癫痫伴精神障碍的治疗效果。方法回顾分析伽玛刀治疗26例颞叶癫痫伴精神障碍的结果,根据临床特点、PET-CT、EEG进行致痫灶定位,应用MASEP-SRRS型旋转式伽玛刀治疗,单纯以杏仁核和海马为靶点时,边缘剂量25～30Gy,等剂量曲线50%,需加照射颞叶皮层致痫灶时,边缘剂量9～14Gy,等剂量曲线45%～50%。采用癫痫的国内疗效评定标准和全国精神外科疗效评定标准进行疗效评定。结果治疗后随访1～6年,26例中,癫痫控制满意9例,显著改善8例,良好5例,有效率84.6%。治疗后精神症状疗效评定:恢复3例,显著进步12例,进步6例,无效5例,总有效率80.8%。结论伽玛刀行杏仁核海马毁损术及联合皮层癫痫灶低剂量照射,对颞叶癫痫伴精神障碍具有明确的疗效,并发症少见。
Objective To investigate the therapeutic effect of Gamma Knife on temporal lobe epilepsy with mental disorders. Methods The results of 26 patients with temporal lobe epilepsy and mental disorders were retrospectively analyzed. According to the clinical features, PET-CT and EEG were used to locate the epileptic foci. MASEP-SRRS rotary gamma knife was used to treat the patients with amygdala, When the hippocampus is the target, the marginal dose is 25-30 Gy and the isodose curve is 50%. When the epileptogenic zone is irradiated by the temporal cortex, the marginal dose is 9-14 Gy and the isodose curve is 45-50%. Efficacy of epilepsy using the domestic evaluation criteria and the national assessment of efficacy of psychosocial surgical evaluation. Results The patients were followed up for 1 to 6 years. Among the 26 cases, 9 were satisfactorily controlled by epilepsy, 8 were significantly improved, 5 were good and the effective rate was 84.6%. After treatment, the assessment of psychiatric symptoms: 3 cases recovered, 12 cases significantly improved, 6 cases improved, 5 cases ineffective and the total effective rate was 80.8%. Conclusions The gamma knife almond nucleus hippocampus lesion and combined cortical epilepsy lesion with low dose irradiation have a clear effect on temporal lobe epilepsy with mental disorders and rare complications.