摘要
目的了解无框架立体定向海马杏仁核毁损术在治疗颞叶内侧癫痫中对神经心理学功能的影响。方法 61名MRI阴性药物难治性颞叶癫痫患者在全麻下行经额旁正中入路无框架立体定向海马杏仁核复合体毁损术;其中23例成人患者分别在术前、术后一周及术后6个月进行了韦氏记忆量表及韦氏智力量表检测评分。结果回访时间14～82个月不等,EngelⅠ级31例,Ⅱ级3例,Ⅲ级8例,Ⅳ级19例,痫性发作消失率(EngelⅠ)51%。手术前受试者的平均记忆商数、平均智力商数都明显低于健康人群中常值范围。术后一周较术前下降(P<0.05)的有语言智商、操作智商及记忆商数,总智商下降不明显(P>0.05);术后6个月以后受试者较术前明显增加(P<0.05)的有总智商、语言智商、操作智商及记忆商数。右颞叶内侧毁损者言语智商较术前明显增加(P<0.05)。结论无框架立体定向海马杏仁核毁损术术后早期存在记忆力及智力下降,但此类认知功能的下降程度较轻,且会在术后6个月内恢复甚至较术前明显改善,远期来讲右侧手术者其语言智商改善更为明显。无框架立体定向海马杏仁核毁损术在神经心理学功能保留方面是可逆的、甚至是有益的。
Objective To evaluate the risk of a decline of neuropsychological functions for frameless stereotactic radiofrequency amygdalohippocampectomy （SAHE） to mesial temporal lobe epilepsy （MTLE）. Methods 61 patients with MTLE were experienced SAHE. Among them, 23 adult patients were compared neuropsychological results before, 7days and 6 monthts after sur- gery with WAIS-- RC and WMS-- RC. Results After 14- 82 months follow-- up, 31 patients were classified as Engel Class I, 3 patients were assessed as Engel II, 8 patients were assessed as Engel []I and 19 patients as Engel IV. The mean scores of neuropsychological examinations inclu- ding IQ and MQ in patients with medial temporal lobe epilepsy were lower than the normal range before operation. Patients showed significantly（P〈〉0.05） descend in verbal IQ, Performance IQ and MQ 7 days after SAHE. No significant changes in Full--scale IQ of all subjects. Six monthts and after SAHE, Full--scale IQ, Verbal IQ, Performance IQ and MQ of treated patients increased significantly （P〉0. 05）. Patients treated on the right side improved in verbal IQ （P〈0〉.05）. No significant changes in memory and intelligence were found in patients treated on the left side （P〈0.05）. Conclusion There have had the risk of a decline of neuropsychological functions in SAHE to mesial temporal lobe epilepsy （MTLE） immediately after surgery. The neuro-psychological deficits were slight and could recover and even improved in six months. Patients have a significant improvement in the verbal IQ who treated on the right side by long--term ob servation. There have a reversible and improved neuropsychological function in frameless stereotactic radiofrequency amygdalohippocampectomy to mesial temporal lobe epilepsy （MTLE）.
出处
《立体定向和功能性神经外科杂志》
2012年第6期321-325,共5页
Chinese Journal of Stereotactic and Functional Neurosurgery
基金
首都临床特色研究项目(编号:Z111107058811018)
关键词
无框架立体定向
海马杏仁核毁损术
颞叶内侧癫痫
记忆商
智商
Frameless stereotactie surgery
Stereotactic radiofrequency amygdalohipp-ocampeetomy （SAHE）
Medial temporal lobe epilepsy
IQ
MQ
