立体定向开放显微手术治疗脑内致痫小病灶

Application of opening stereotactic micro-neurosurgical operation to treat epileptogenic small brain lesion

目的 脑内致癫痫小病灶术前、术中的精确定位和病灶切除，是手术治疗效果的关键。探讨立体定向开放微创手术，皮层电极监测下切除脑内致痫小病灶的手术方法。方法 53例症状性癫痫病例，CT、MRI检查有脑内小病灶（直径在0.5～3．0cm），24h视频脑电图确认致痫灶为脑内单发病灶。ASA 601S型立体定向仪CT引导辅助全麻环钻开颅，导针穿刺放置导管引导，显微镜下手术分离、切除病灶，皮层脑电图确认将致痫灶切除。结果 病灶全切率达96．2％，术后50例得到随访，随访时间5～12个月，平均6．3个月，癫痫消失45例，脑电图检查记录到癫痫波11例，临床癫痫发作5例。因肺癌死亡3例。结论 CT立体定向引导，显微手术切除颅内致痫小病灶，术中皮层电极确认将致痫灶切除，是一种定位精确、微创、安全、有效的治疗方法。

Objective To explore the method of resection small epileptogenic brain lesion by CT-guided opening stereotactic micro-neurosurgical operation, Methods A total of 53 cases of epilepsy that had epileptngenic focus in brain were operated in opening stereotactic microsurgery by cr guidance and applied trephination, The electrocorticngraphy （ECoG） was applied to record the spike wave before resection of the focus and again after resection. If ECoG still recorded spike wave, it was necessary to continue to resect the area by multiple subpial trausections or cortex thermocoagulation. Results A total of 51 lesions were totally removed in 53 cases. After operation, 7 patients appeared seizure in hospital. Follow-up ranged from 5 months to 12 months. After operation, seizure disappeared in 45 cases. Eleven cases still had spike wave and 5 cases still had seizure. Three cases died due to lung cancer. Conclusion CT guided opening stereotactic microsurgical operation combined with ECoG is an effective method to resect epileptogenic small brain lesion.