【作者】 陈涛；

【导师】 蒋宇钢；

【作者基本信息】 中南大学 ， 外科学， 2010， 硕士

【摘要】 目的：探讨颞叶癫痫的术前定位手段,术中皮层脑电监测下致痫灶的切除及术后并发症控制。方法：湘雅二医院自2006年5月到2009年4月共行手术治疗87例颞叶癫痫患者。所有患者术前均行视频脑电图(V-EEG)和影像学(MRI)检查、术中行皮层脑电图(ECoG)检查、术后行影像学(MRI)复查。本文进行回顾性分析了术前评估定位手段,术中脑电监测的意义。结果：所有患者根据视频脑电图(V-EEG)和MRI等无创检查定位了致痫灶。术中用皮层脑电图(ECoG)作监测,明确痫灶的部位和范围.术后至少常规服用抗癫痫药物2年,根据临床发作情况、脑电图检查结果决定是否停药。本组随访1-2年。疗效按Engel的标准评定,71例(81.6%)患者无癫痫发作(Engel-Ⅰ级),12例(13.8%)患者临床发作明显减少(Engel-Ⅱ级),4例(4.6%)患者仍有癫痫发作(Engel-Ⅲ级),但程度减轻,发作时间缩短。80例(91.2%)患者的神经心理功能均有不同程度改善。结论：应用显微外科技术治疗颞叶癫痫是一种安全、有效的方法；术前进行视频脑电图(V-EEG)和MRI对颞叶癫痫致痫灶精确定位,对设计切除方式有重要参考价值。术中用皮层脑电图(ECoG)作监测,明确痫灶的部位和范围,以免术后残留痫灶。同时切除病灶及致痫灶是控制癫痫发作、改善预后的有效手段,及减少并发症,提高疗效的关键。更多还原

【Abstract】 Objective:To explore the methods of presurgical location in patients with temporal lobe epilepsy,electrocorticogram (ECoG).monitoring in the surgical treatment of temporal lobe epilepsy and control of postoperative complications.Methods:The clinical data of 87 postoperative patients from 2nd XiangYa Hospital, from 2006 to 2009, who underwent surgical treatment of temporal lobe epilepsy were retrospectively analyzed. All the patients were monitored by Video electroencephalography(VEEG) and Magnetic Resonance Imaging(MRI) before operation, by electrocorticogram (ECoG)monitoring in the operation. Patients were closely monitored with MRI postoperative.Results:All patients according to the video electroencephalogram (VEEG) and magnetic resonance imaging (MRI) located epileptogenic zone as a noninvasive check. By using electrocorticogram (ECoG)monitoring in the operation,we can know the position and range of epileptogenic zone better.Taking an antiepileptic drug at least 2 year after operation, According to the clinical onset, EGG results determineed whether withdrawal.87 patients were followed up for 1 year to 2 years, the clinical attack was controlled completely in 71(81.6%) patients(Engel-Ⅰ), the times of clinical attack were decreased significantly in 12(13.8%) patients(Engel-Ⅱ),4(4.6%) patient still to remain epileptic seizure, but the degree relieved, and the seizure time shortened(Engel-Ⅲ). The nerves psychological function improved to different extent in 80patients(91.2%).Conclusions:Using microsurgical techniques for the treatment of temporal lobe epilepsy is a safe and effective method. On preoperative video electroencephalogram (VEEG) and magnetic resonance imaging (MRI) of temporal lobe epilepsy epileptogenic zone resection for accurate positioning, design method had important reference value. By using electrocorticogram (ECoG)monitoring in the operation,we can know the position and range of epileptogenic zone better. While epileptogenic zone resection of the lesion and control seizures, improve the prognosis of effective means, and reduce the complications, enhance the curative effect of the key.更多还原