Immonen A, Jutila L, Kälviäinen R, Mervaala E, Partanen K, Partanen J, Vanninen R, Ylinen A, Alafuzoff I, Paljärvi L, Hurskainen H, Rinne J, Puranen M, Vapalahti M
Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland.
Adv Tech Stand Neurosurg. 2004;29:87-132. doi: 10.1007/978-3-7091-0558-0_3.
Temporal lobe epilepsy (TLE) is the most common type of refractory epilepsy. The mechanisms of epileptogenesis and seizure semiology of the mesial and neocortical temporal lobe epilepsy are discussed. The evaluation and selection of patients for TLE surgery requires team work: the different clinical aspects of neuropsychological evaluation, magnetic resonance and functional imaging (positron emission tomography, single photon emission computed tomography and magnetoenephalography) are reviewed. In our programme of epilepsy surgery at Kuopio University Hospital, Finland, we have performed 230 temporal resections from 1988 until 2002. Preoperative diagnostic EEG-videotelemetry often required intracranial monitoring and it has proved to be safe and efficient. The indications and technique for tailored temporal lobe resection with amygdalohippocampectomy used in our institution, as well as the complications, are described. Our analysis of outcome after temporal lobe surgery included 140 consecutive adult patients between 1988 and 1999; one year after the operation in unilateral TLE the Engel I-II outcome was observed in 68% of the patients. Outcome of surgery improved significantly after introduction of the standardised MR imaging protocol from 1993; 74% of patients with unilateral TLE achieved Engel I-II outcome.
颞叶癫痫（TLE）是最常见的难治性癫痫类型。本文讨论了内侧和新皮质颞叶癫痫的癫痫发生机制和发作症状学。TLE手术患者的评估和选择需要团队协作：本文回顾了神经心理学评估、磁共振成像和功能成像（正电子发射断层扫描、单光子发射计算机断层扫描和脑磁图）等不同的临床方面。在芬兰库奥皮奥大学医院的癫痫手术项目中，从1988年到2002年我们共进行了230例颞叶切除术。术前诊断性脑电图视频遥测通常需要颅内监测，事实证明其安全且有效。本文描述了我们机构中使用的杏仁核海马切除术进行定制颞叶切除术的适应症、技术以及并发症。我们对颞叶手术后结果的分析纳入了1988年至1999年间连续的140例成年患者；单侧TLE患者术后一年，68%的患者达到恩格尔I-II级结果。1993年引入标准化磁共振成像方案后，手术结果显著改善；74%的单侧TLE患者达到恩格尔I-II级结果。
