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目的探讨双侧海马-杏仁核复合体毁损术治疗双侧颞叶癫的疗效。方法回顾性分析5例双侧颞叶癫病人的临床资料,复杂部分性发作中的自动症1例,部分性继发全身性癫4例。均行深部电极引导下机器人辅助定位双侧海马-杏仁核复合体毁损术。结果随访1～2.5年,按Engel分级:Ⅰ级2例;Ⅱ、Ⅲ、Ⅳ级各1例。术后MRI显示:双侧海马-杏仁核复合体区无严重的结构性破坏。智商、心算速度、符号数字配对、划消、数字记忆广度、指扣试验等神经心理学检查指标手术前后差异均无统计学意义(P>0.05)。结论双侧颞叶癫无法实施切除性手术,而立体定向外科治疗可减少癫发作,且并未造成严重认知功能障碍,是一种值得尝试的外科治疗手段。
Objective To investigate the curative effect of bilateral hippocampal-amygdala composite destruction on bilateral temporal lobe epilepsy. Methods The clinical data of 5 patients with bilateral temporal lobe epilepsy were retrospectively analyzed. One case of autoimmune in complex partial seizures and 4 cases of partial sequela of generalized epilepsy were retrospectively analyzed. Deep electrode-guided robotic-assisted localization of both bilateral hippocampus-amygdala complex ablation. Results The patients were followed up for 1 to 2.5 years. According to Engel classification, there were 2 cases of grade Ⅰ and 1 case of grade Ⅱ, Ⅲ and Ⅳ. Postoperative MRI showed no serious structural damage in the bilateral hippocampus-amygdala complex area. There were no significant differences in the indexes of neuropsychological tests such as IQ, mental arithmetic speed, sign matching, demarcation, digital memory breadth, finger bond test and so on before and after operation (P> 0.05). Conclusions Bilateral temporal lobe epilepsy can not be performed surgeries. Stereotactic surgical treatment can reduce the incidence of epilepsy and does not cause serious cognitive dysfunction. It is a worthwhile attempt to surgical treatment.