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1、616中华外科杂志2005年5月第43卷第9期ChinJSurg,May2005,Vo.l43,No.9.神经外科立体定向杏仁核与海马联合毁损治疗颞叶内侧型癫痫杨卫东毓青张建宁申长虹王凤楼崔林阳李红杨树源摘要!目的探讨立体定向杏仁核、海马联合毁损治疗颞叶内侧型癫痫(MTLE)的方法。方法患者头部安装Leksell立体定向框架,使其平行于颞角长轴。针对23例一侧MTLE患者,应用核磁共振(MRI)扫描定位、深部电极杏仁核及海马脑电监测和射频毁损技术,局部麻醉下分别经旁正中额、枕入路完成立体定向杏仁核和海马毁损术。结果射频
2、毁损前23例患者深部电极均记录到杏仁核和海马区域棘波或多棘波,术后痫样放电消失。术后1~2周复查MRI显示与毁损部位相一致的广泛凝固性坏死,周围有水肿带。术后随访8~32个月,癫痫发作完全控制者4348%(10/23例),总有效率(发作减少∀50%)9130%(21/23)。结论立体定向杏仁核、海马联合毁损治疗MTLE是一种安全有效的微创治疗方法,值得临床推广和应用。关键词!癫痫,颞叶;杏仁核;海马Stereotacticcombinedamygdalaandhippocampuslesionsfortreatmentofmedialtemp
3、orallobe*epilepsyYANGWeidong,YUQing,ZHANGJianning,SHENChanghong,WANGFenglou,CUILin*yang,LIHong,YANGShuyuan.DepartmentofNeurosurgery,GeneralHospital,TianjinMedicalUniversity,Tianjin300052,ChinaCorrespondingauthor:YANGWeidong,Email:yangweidongshine@yahoo.caAbstract!Objecti
4、veToexplorethetechniquesofstereotacticcombinedamygdalohippocampotomyformanagementofmedialtemporallobeepilepsy(MTLE).MethodsTheLeksellstereotacticframewasusedforallcases,andwhichalmostparalleledthelongaxisofhippocampus.Stereotacticamygdalohippocampotomywasperformedin23patientswi
5、thunilateralmedialtemporallobeseizuresbyusingmagneticresonanceimaging(MRI)localizationfortargetplanning,depthelectrodefortheelectroencephalogram(EEG)monitoringandradiofrequencytechniquesforlesionproduction.Allprocedureswerecompletedunderlocalansthesia.ResultsPrelesionspikesorpol
6、yspikewavescomplexwererecordedbyadepthelectrodeintheamygdalaandhippocampusregioninallpatients,andtheepileptiformdischargesdisappearedaftertheamygdalohippocampotomy.TheMRIappearanceofthelesionareasafter1~2weekssurgicaloperationshowedthatmutipleareasofcoagulationnecrosiscorrespond
7、ingtothelesionsitesweresurroundedbyzonesofedema.Twentythreepatientswerefollowedupto8~32monthswithseizurefree4348%(10/23),andthegeneralefficency(seizurereduction∀50%)was9130%(21/23cases).ConclusionsStereotacticcombinedlesionsofunilateralamygdalaandhippocampusforminimallyinvas
8、ivetreatmentofMTLEissafeandeffective,and
