Li Han-Tao, Lee Ching-Yi, Lim Siew-Na, Chang Chun-Wei, Lee Shih-Tseng, Wu Tony
Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan.
Department of Neurosurgery, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan.
World Neurosurg. 2016 Dec;96:612.e21-612.e25. doi: 10.1016/j.wneu.2016.08.112. Epub 2016 Sep 4.
Surgical interventions are often used for freedom from seizure in patients with drug-resistant mesial temporal lobe epilepsy. A patient with seizure foci in the left mesiotemporal region underwent limited-size stereotactic radiofrequency thermocoagulation (RF-TC) over the left hippocampus.
A 37-year-old woman with febrile convulsion in her childhood was admitted to our neurologic department with complex partial seizure with secondary generalization. Electroencephalography showed epileptogenic focus mainly from the left mesiotemporal region, and magnetic resonance imaging confirmed a left hippocampal atrophy. Because of failure to control seizure after use of several antiepileptic drugs, drug-resistant mesial temporal lobe epilepsy was diagnosed. RF-TC was done in the left hippocampus. Unique features of our technique include intraoperative electroencephalography recordings directly from electrodes on the left hippocampus, an aura sensation provoked during the low-temperature test thermocoagulation, and therapeutic thermocoagulation performed via a Radionics radiofrequency lead. In the 16-week period following the surgery, the patient experienced no seizure attacks and no significant postoperative adverse effects or memory impairments. Compared with other reports using RF-TC, our case demonstrates a 1-step minimally invasive surgery that reduces hippocampal volume loss, shortens the length of hospital stay, decreases the occurrence of postoperative infection, and achieves good outcomes for epilepsy control.
Favorable seizure control was achieved with minimally invasive RF-TC. Further use of this technique is warranted in cases of drug-resistant mesial temporal lobe epilepsy.
手术干预常用于药物难治性内侧颞叶癫痫患者以实现无癫痫发作。一名左侧颞叶内侧区域存在癫痫病灶的患者接受了左侧海马体的有限尺寸立体定向射频热凝术（RF-TC）。
一名童年时有高热惊厥的37岁女性因复杂部分性发作继发全身性发作入住我院神经科。脑电图显示致痫灶主要来自左侧颞叶内侧区域，磁共振成像证实左侧海马萎缩。因使用多种抗癫痫药物后癫痫发作未能得到控制，诊断为药物难治性内侧颞叶癫痫。在左侧海马体进行了RF-TC。我们技术的独特之处包括术中直接从左侧海马体电极进行脑电图记录、低温测试热凝期间引发的先兆感觉以及通过Radionics射频导线进行治疗性热凝。术后16周内，患者未出现癫痫发作，也没有明显的术后不良反应或记忆障碍。与其他使用RF-TC的报告相比，我们的病例展示了一种一步式微创手术，可减少海马体体积损失、缩短住院时间、降低术后感染发生率，并在癫痫控制方面取得良好效果。
微创RF-TC实现了良好的癫痫控制。对于药物难治性内侧颞叶癫痫病例，有必要进一步应用该技术。
