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目的探讨应用立体定向技术双侧海马置入深部电极脑电监测对颞叶癫痫的定侧定位价值。方法对15例无创影像及脑电检查难以定侧定位的颞叶癫痫患者,在MR定位引导下行立体定向双侧海马深部电极置入,视频脑电监测描记发作期及发作间期脑电图,根据监测结果对癫痫灶进行定侧定位,行个体化癫痫外科手术治疗,术后正规口服抗癫痫药物并随访。结果术后随访最长44个月,最短8个月,平均21个月。疗效满意8例(54%),显著改善5例(33%),良好2例(13%)。术后1例出现视野缺损,无其他严重并发症。结论立体定向双侧海马深部电极置入及脑电监测,微创、安全、准确,是难治性颞叶癫痫定侧定位的可靠的方法,对制定个体化手术方案具有决定性作用。
Objective To investigate the stereotactic localization of temporal lobe epilepsy by stereotactic bilateral hippocampal implantation of deep electrodes. Methods Totally 15 cases of temporal lobe epilepsy with noninvasive imaging and EEG were located in bilateral temporal hippocampus under magnetic resonance imaging (MR) localization. Video EEG was used to record the epileptic seizure and interictal EEG. According to the monitoring results, the epileptic foci were located side-by-side and were treated with individualized epilepsy surgery. The regular oral antiepileptic drugs were followed up. Results The longest postoperative follow-up 44 months, the shortest 8 months, an average of 21 months. Eight patients (54%) responded satisfactorily, five (33%) significantly improved and two (13%) had good outcome. A case of visual field defect after surgery, no other serious complications. Conclusion Stereotactic bilateral hippocampal deep electrode placement and EEG monitoring are minimally invasive, safe and accurate. They are reliable methods for the localization of refractory temporal lobe epilepsy. They are decisive for the development of individualized surgical plans.