Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota.
Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida.
Oper Neurosurg (Hagerstown). 2020 Jan 1;18(1):E19-E22. doi: 10.1093/ons/opz098.
Temporal lobe encephaloceles are increasingly recognized as a potential cause of medically refractory epilepsy and surgical treatment has proven effective. Resection of the encephalocele and associated cortex is often sufficient to provide seizure control. However, it is difficult to determine the extent of adjacent temporal lobe that should be resected. We present a case report and our technique of a tailored inferior temporal pole resection.
A 32-yr-old man with an 11-yr history of medically refractory epilepsy. Prolonged electroencephalography (EEG) revealed frequent left and rare right frontotemporal sharp waves. Numerous seizures were captured with EEG, all of which originated from the left temporal region. Statistical parametric mapping (SPM) subtraction ictal-interictal SPECT coregistered with magnetic resonance imaging (MRI) (SISCOM) demonstrated ictal hyperperfusion in the anterior left temporal lobe. MRI showed 2 encephaloceles in the left anterior temporal lobe with the accompanying bony defects in the floor of the middle cranial fossa apparent on the computed tomography scan. The patient underwent left temporal craniotomy with intraoperative electrocorticography, resection of the encephaloceles, and a tailored inferior temporal lobectomy (IFTL) and repair of the middle fossa defects. At 7 mo follow up he reported seizure-freedom since surgery.
Resection of temporal encephalocele and adjacent cortex is safe and effective procedure for select patients with medically refractory epilepsy. This video demonstrates our technique which provides a more standardized approach to the resection.
颞叶脑膨出越来越被认为是药物难治性癫痫的潜在原因，且手术治疗已被证实有效。切除脑膨出及其相关皮层通常足以控制癫痫发作。然而，很难确定应该切除的相邻颞叶的范围。我们报告了一例病例，并介绍了我们定制的下颞极切除术技术。
一名 32 岁男性，患有药物难治性癫痫 11 年。长时间脑电图（EEG）显示左侧频繁出现额颞部棘波，右侧偶有棘波。EEG 记录到多次癫痫发作，均起源于左侧颞叶。统计参数图（SPM）减法发作间期 SPECT 与磁共振成像（MRI）配准（SISCOM）显示左侧前颞叶发作期过度灌注。MRI 显示左侧前颞叶有 2 个脑膨出，伴有颅中窝底部的骨缺损，CT 扫描可见。患者接受了左侧颞骨开颅术，术中进行了皮质脑电图检查、脑膨出切除和定制的下颞叶切除术（IFTL）以及中颅窝缺陷的修复。术后 7 个月随访时，患者报告自手术后无癫痫发作。
对于部分药物难治性癫痫患者，切除颞叶脑膨出和相邻皮层是一种安全有效的方法。该视频演示了我们的技术，为切除提供了更标准化的方法。
