Stepień L, Bacia T, Bidziński J, Wisławski J
Neurosurg Rev. 1981;4(2):61-9. doi: 10.1007/BF01837748.
In our clinic at the Medical Academy in Warsaw 282 patients with temporal lobe epilepsy were treated surgically. The causes of the illness were trauma in 43.2%, including birth trauma in 19.5%, infections diseases in early life in 19.8%, and microtumours in 6.8%. In 30% the aetiology was unknown. Fifty per cent had fits before 10 years and 75% before 20 years of age. The period of conservative treatment was on average nine years. Serial and stereo-EEG recordings including activation by ketamine, as well as intracarotid sodium amytal tests were performed routinely. The interictal EEG epileptiform abnormalities were found most frequently in both temporal lobes (154 cases). The operation was carried out according to Penfield's technique, with electrocorticography and resection of the temporal lobe extending for 6 to 10 cm in the nondominant hemisphere and for 4 to 5 cm in the dominant hemisphere using suction technique. In 75% microscopical changes in the hippocampus were found, in 20% so-called hamartomas and in 6.8% small gliomas. Two patients died and in 13 patients there was a hemiparesis which was transient in 10. The authors present the analysis of late results of 262 cases with a follow-up from 2 to 22 years after operation. Very good results were obtained in 127 cases (48.5%) - no attacks since leaving the clinic. Good results were observed in 42 patients (16%) - not more than 1-2 attacks a year. Thus, the operation resulted in freedom from attacks, or nearly so, in 169 cases (64.5%). In an additional 47 patients (18%) there was a significant reduction (at least 50%) in seizures without complete freedom from attacks, and in 44 cases (16.8%) no improvement was observed. The analysis of our series suggests that the best results may be obtained in patients with unilateral temporal EEG changes. The existence of an additional focus in parts of the other temporal lobe does not impair the operative results when the dominant epileptic focus has been removed. Among 24 cases with equally pronounced bitemporal EEG abnormalities the stereo-EEG studies allowed detection of the epileptic focus in 13 patients (54%). Detailed analysis of the results, obtained in 51 children below 15 years of age, led to the conclusion that temporal lobe epilepsy should be operated upon even in young children, provided that the epileptic focus can be clearly identified.
在华沙医学院我们的诊所，对282例颞叶癫痫患者进行了外科治疗。病因包括创伤的占43.2%，其中出生时创伤占19.5%，早年感染性疾病占19.8%，微肿瘤占6.8%。30%的病因不明。50%的患者在10岁前发病，75%在20岁前发病。保守治疗的平均时间为9年。常规进行包括氯胺酮激活的系列和立体脑电图记录以及颈动脉内阿米妥钠试验。发作间期脑电图癫痫样异常最常见于双侧颞叶（154例）。手术按照彭菲尔德技术进行，采用皮质脑电图监测，使用吸引技术在非优势半球切除颞叶6至10厘米，在优势半球切除4至5厘米。75%的患者海马有微观改变，20%有所谓的错构瘤，6.8%有小胶质瘤。2例患者死亡，13例患者出现偏瘫，其中10例为短暂性偏瘫。作者对262例患者术后2至22年的远期结果进行了分析。127例（48.5%）取得了非常好的效果——出院后无发作。42例（16%）观察到良好效果——每年发作不超过1 - 2次。因此，手术使169例（64.5%）患者免于发作或几乎免于发作。另外47例（18%）患者发作明显减少（至少减少50%）但未完全无发作，44例（16.8%）未见改善。对我们系列病例的分析表明，单侧颞叶脑电图改变的患者可能获得最佳效果。当主要癫痫病灶被切除时，另一颞叶部分存在额外病灶并不影响手术效果。在24例双侧颞叶脑电图异常同样明显的病例中，立体脑电图研究在13例患者（54%）中检测到了癫痫病灶。对51例15岁以下儿童的结果进行详细分析后得出结论，只要能明确识别癫痫病灶，即使是幼儿也应进行颞叶癫痫手术。
