目的 探讨儿童颞叶癫痫的手术治疗及其疗效.方法 回顾性纳入2016年9月至2018年6月首都儿科研究所附属儿童医院神经外科收治的21例颞叶癫痫患儿,根据患儿的症状学、影像学及神经电生理学评估结果制定个体化的手术治疗方案,其中13例行标准前颞叶切除术,3例行占位病变扩大切除术,2例行杏仁海马切除术,1例行单纯颞叶内侧占位切除术,1例行畸形血管团切除术,1例行前颞叶+额叶结节切除术.术后对所有患儿行临床随访,随访内容包括复查头颅MRI和脑电图,对随访时间≥1年的患儿行Engle评级.结果 21例患儿的手术均成功,术后无一例发生严重并发症.病理学检查结果为:混合性神经元-胶质肿瘤14例,多形性黄色瘤型星形细胞瘤1例,海马硬化3例,局灶性皮质发育不良Ⅱb型1例,结节性硬化症1例,脑动静脉畸形1例.21例患儿的随访时间为(18.0±5.9)个月(9～30个月).复查头颅MRI显示,所有患儿的病灶均全部切除,且未见复发.复查脑电图显示,1例患儿术侧颞叶区仍有大量的痫样放电,其余20例较术前均明显减少或消失.18例患儿的随访时间≥1年,Engle分级为,Ⅰ级17例,Ⅳ级1例.结论 根据颞叶癫痫患儿的症状学、影像学及神经电生理学评估结果制定个体化的手术方案,术后可获得较好的预后.%Objective To explore the surgical treatment and outcomes of temporal lobe epilepsy in children. Methods A retrospective analysis was conducted on 21 children with temporal lobe epilepsy admitted to Department of Neurosurgery, Children's Hospital Affiliated to Capital Institute of Pediatrics from September 2016 to June 2018. Individualized surgical treatment plan was formulated according to the semeiology, imaging and electroneurophysiological findings of the children. Standard anterior temporal lobectomy was undergone in 13 cases, enlarged resection of temporal lobe lesion in 3, selective hippocampal amygdala resection in 2, simple resection of medial temporal lobe lesion in 1, vascular malformation resection in 1, and anterior temporal lobe resection plus frontal lobe nodule resection in 1. All patients were followed up clinically after operation. The follow-up included cranial MRI, electroencephalogram and Engle rating. Results All 21 patients underwent successful operation. No serious complications occurred after surgery. The pathological results were mixed neuronal-glial tumor in 14 cases, pleomorphic xanthoastrocytoma in 1, hippocampal sclerosis in 3, focal cortical dysplasia IIb in 1, tuberous sclerosis in 1, and cerebral arteriovenous malformation in 1. The follow-up duration of 21 patients was 18. 0 ± 5. 9 months (9-30 months). A review of head MRI showed that all tumors were completely resected and no recurrence was seen of the patients with tumor. A review of the EEG showed that there was still a large amount of epileptic discharges in the temporal lobe of 1 patient, and the epileptic discharges of the remaining 20 cases were significantly reduced or disappeared compared with preoperative conditions. Eighteen patients were followed up for more than 12 months. Up to the last follow-up, 17 cases were classified as EngleⅠand 1 as Engle Ⅳ. Conclusion Individualized surgical procedures based on comprehensive assessment of the semeiology, imaging and electroneurophysiology of children with temporal lobe epilepsy could lead to good outcomes.
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