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目的分析影响与颞叶相关癫痫患者手术疗效的相关因素,探讨不同类型颞叶相关癫痫的手术效果。方法对37例颞叶相关癫痫患者依据神经影像学、临床症状学及神经电生理、神经心理学进行术前术后综合评估,术前、术后进行对照分析,判定手术疗效。结果术后病理海马硬化3例,囊肿1例,低级别胶质瘤2例,胚胎发育不良性神经上皮肿瘤1例,脑软化灶3例,胶质细胞增生、皮层分层紊乱23例,海绵状血管瘤3例,慢性炎性细胞浸润1例。术后随访一年以上,Engel I级18例,Engel II级16例,Engel III级2例,Engel IV级1例。无严重并发症及手术死亡病例。2例出现并发症:短暂性记忆减退1例,出院时已完全恢复至术前水平,精神障碍加重1例。结论影响术后疗效的主要因素在于对神经影像学、临床症状学及电生理学的正确判读,三者定位一致的颞叶相关癫痫患者和颞叶影像学有阳性发现的患者,术后疗效较好;对于颞叶影像学有结构性病变,但临床症状表现为全面性发作的患者,选择正确的手术方式,仍可取得满意疗效。
Objective To analyze the related factors affecting the surgical outcome of patients with temporal lobe epilepsy and to explore the surgical effects of different types of temporal lobe epilepsy. Methods Thirty-seven patients with temporal lobe-related epilepsy were evaluated preoperatively and postoperatively according to neuroimaging, clinical symptoms, neuroelectrophysiology and neuropsychology. Preoperative and postoperative comparisons were performed to determine the effect of the surgery. Results Postoperative histopathology hippocampus sclerosis in 3 cases, 1 case of cyst, 2 cases of low grade glioma, 1 case of embryonic dysplastic neuroepithelial neoplasia, 3 cases of cerebral softening, glial cell proliferation, cortical stratification in 23 cases, sponge 3 cases of hemangioma, 1 case of chronic inflammatory cell infiltration. The patients were followed up for more than one year. There were 18 cases of Engel I, 16 cases of Engel II, 2 cases of Engel III and 1 case of Engel IV. No serious complications and surgical deaths. Complications in 2 cases: transient memory loss in 1 case, discharged to the preoperative level has been fully restored, mental disorders increased in 1 case. Conclusions The main factors influencing postoperative efficacy are correct interpretation of neuroimaging, clinical symptomology and electrophysiology. The patients with temporal lobe-related epilepsy and temporal lobe imaging findings with consistent location of the three have a better postoperative outcome ; For temporal lobe imaging with structural lesions, but the clinical symptoms of patients with a comprehensive attack, choose the correct surgical approach, can still be satisfied with the results.