婴幼儿期脑出血继发耐药性癫痫患者的手术疗效分析

Surgical efficacy analysis of patients with drug-resistant epilepsy secondary to cerebral hemorrhage in infant period

目的探讨婴幼儿期脑出血继发耐药性癫痫患者手术干预的疗效。方法选取上海徳济医院癫痫中心2017年3月至2023年10月接受立体定向脑电图(SEEG)定位并手术干预的患者共5例,收集其临床基线资料,并进行预后评估。结果5例患者平均年龄为(21.8±3.8)岁。既往均有婴幼儿期脑出血病史。手术后随访时间为3~7年、平均时间(5.6±1.4)年,术后患者发作减少>90%3例,发作减少50%~90%2例。随访发作结果以Engel评分进行统计,其中EngelⅠ级1例,EngelⅡ级2例,EngelⅢ级2例。SEEG精确定位手术后的患者生活能力均明显进步,主要集中在癫痫发作减少≥50%的患者,癫痫发作控制后患者的生活能力及社会能力均得到提高;其中1例患者术后发生脑积水,行侧脑室—分流术后发作较术前明显缓解;5例患者术后均无明显并发症。结论婴幼儿期脑出血继发耐药性癫痫患者采取手术治疗可明显减少癫痫发作,能够很大程度改善患者的生活质量。

Objective To investigate surgical efficacy of patients with drug-resistant epilepsy secondary to cerebral hemorrhage in infant period.Methods Patients who underwent stereoelectroencephalography(SEEG)and surgical intervention were selected at Epilepsy Center from Shanghai Neuromedical Center from March 2017 to October 2023.Clinical baseline data were collected.The prognosis was evaluated.Results The average age of 5 patients was 21.8±3.8 years old.They had the history of cerebral hemorrhage in infant period.The follow-up period after surgery was 3-7 years,with an average follow-up time of 5.6±1.4 years.After surgery,there were 3 cases with epileptic seizure reduction greater than 90%and 2 cases with epileptic seizure reduction of 50%~90%.Engel grade was used to statistically analyze follow-up seizure results,and there was 1 case with Engel gradeⅠ,2 cases with Engel gradeⅡand 2 cases with Engel III grade.After precise positioning by SEEG and surgery,the living ability of the patients was significantly improved.Both living and social abilities of the patients with epileptic seizure reduction≥50%were improved after controlling epileptic seizures.One patient developed hydrocephalus after surgery,and the seizures were significantly relieved after lateral ventricular shunt when compared to before surgery.There were 5 patients without significant postoperative complications.Conclusions Surgery may remarkably reduce epileptic seizures of patients with drug-resistant epilepsy secondary to cerebral hemorrhage in infancy and improve quality of life of the patients to a great extent.