立体定向海马杏仁核复合体毁损术治疗MRI阴性与MRI阳性颞叶癫(癎)疗效的差异

目的 观察深部脑电记录电极引导立体定向手术治疗顽固性癫(癎)的手术疗效,并对照术前MRI阳性患者与MRI阴性患者手术疗效差别.方法 对267例顽固性癫(癎)患者采用深部脑电记录电极引导立体定向脑内核团毁损术,并对其中127例进行回访,对回访结果行Engel分级评定,根据患者MRI表现是否阳性将获访患者分为两组,计算两组患者(癎)性发作消失率、显效率、有效率及无效率,并对其间差异分别作统计学分析.结果 随访2 ～70个月,Engel分级Ⅰ级41例,Ⅱ级7例,Ⅲ级22例,Ⅳ级57例,总体(癎)性发作消失率32％.MRI阴性患者组(癎)性发作消失率50％.MRI阳性组(癎)性发作消失率16％.经比较,两组患者(癎)性发作消失率的差别有统计学意义(x2=16.33,P＜ 0.005).结论 头颅MRI示阴性者手术疗效较头颅MRI有阳性发现者手术疗效明显要好,推荐MRI阴性的药物难治性癫(癎)患者首选立体定向毁损.

Difference in therapeutic efficacy about RF-thermocoagulation of amygdala-hippocampus complex in stereotactic surgery for intractable MRI-negative and MRI-positive temporal lobe epilepsy

Objective To evaluate therapeutic efficacy of deep-brain electrode-guided stereotactic surgery for intractable MRI-negative and MRI-positive temporal lobe epilepsy. Methods 256 patients with temporal lobe epilepsy were treated with deep-brain electrode-guided stereotactic RF-thermo- coagulation of amygdala-hippocampus complex. 127 of them were followed-up according to Engel standard of curative effect, then divided into MRI-negative and MRI-positive groups to figure out the difference in therapeutic efficacy. Results The followed up time was 2-70 months. There was Engel in 41 patients, Engelllin 7, Engel m in 22, and Engel 1V in 57. MRI-negative group completely control of seizures were achieved in 50% ; MRI-positive group completely control of seizures were only achieved in 16%. There was significant difference in therapeutic efficacy （~2 = 16.33 ,P 〈 0.005）. Conclusion Choosing MRI-negative patients to operative are the key factors to improve the therapeutic efficacy of stereotactic RF-thermo-coagulation surgery for temporal lobe epilepsy.