前颞叶切除术治疗单纯疱疹病毒性脑炎所致难治性癫痫持续状态
Anterior Temporal Lobectomy for Refractory Status Epilepticus in Herpes Simplex Encephalitis.
作者信息
Bick Sarah K B, Izzy Saef, Rubin Daniel B, Zafar Sahar F, Rosenthal Eric S, Eskandar Emad N
机构信息
Department of Neurosurgery, Massachusetts General Hospital, Wang 021, 55 Fruit Street, Boston, MA, 02114, USA.
Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.
出版信息
Neurocrit Care. 2016 Dec;25(3):458-463. doi: 10.1007/s12028-016-0302-6.
BACKGROUND
Herpes simplex virus (HSV) is a common cause of viral encephalitis that can lead to refractory seizures. The primary treatment of HSV encephalitis is with acyclovir; however, surgery sometimes plays a role in obtaining tissue diagnosis or decompression in cases with severe mass effect. We report a unique case in which anterior temporal lobectomy was successfully used to treat refractory status epilepticus in HSV encephalitis.
METHODS
Case report and review of the literature.
RESULTS
We report a case of a 60-year-old man with HSV encephalitis, who presented with seizures originating from the right temporal lobe refractory to maximal medical management. Right anterior temporal lobectomy was performed for the purpose of treatment of refractory status epilepticus and obtaining tissue diagnosis, with ultimate resolution of seizures and excellent functional outcome.
CONCLUSIONS
We suggest that anterior temporal lobectomy should be considered in cases of HSV encephalitis with refractory status epilepticus with clear unilateral origin.
背景
单纯疱疹病毒（HSV）是病毒性脑炎的常见病因，可导致难治性癫痫发作。HSV脑炎的主要治疗方法是使用阿昔洛韦；然而，在具有严重占位效应的病例中，手术有时在获取组织诊断或减压方面发挥作用。我们报告了一例独特的病例，其中前颞叶切除术成功用于治疗HSV脑炎所致的难治性癫痫持续状态。
方法
病例报告及文献复习。
结果
我们报告一例60岁男性HSV脑炎患者，其表现为起源于右侧颞叶的癫痫发作，经最大程度的药物治疗仍难治。为治疗难治性癫痫持续状态并获取组织诊断而进行了右侧前颞叶切除术，癫痫发作最终得到缓解，功能预后良好。
结论
我们建议，对于起源明确且为单侧的难治性癫痫持续状态的HSV脑炎病例，应考虑行前颞叶切除术。
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