难治性癫痫的术前评估和外科治疗(附17例临床总结)

Presurgical evaluation and surgical treatment of medically refractory epilepsy (Reports of 17 cases).

目的 探讨难治性癫痫术前评估和外科治疗方法。方法 17例患者 ,临床表现单纯部分性发作 4例 ,单纯部分性发作继发全身强直 阵挛性发作 4例 ,全身强直 阵挛性发作 2例 ,复杂部分性发作 3例 ,复杂部分性发作伴全身强直 阵挛性发作 3例 ,失神发作伴全身强直 阵挛性发作 1例。术前均经神经电生理检查和影像学检查 ,4例行前颞叶切除术 (包括杏仁核和大部分海马 ) ,12例行致痫灶 +致痫病灶切除术 ,1例行额极切除术。结果 5例患者术后癫痫发作完全消失 ,8例发作显著改善 ,2例改善较好 ,1例改善较差 ,1例发作无改善 ,手术总有效率为 88 2 % ,大部分患者生活质量较术前提高 ,恢复工作和学习。结论 外科手术是治疗难治性癫痫的一种有效方法 ,但手术前应准确定位致痫灶 ,并选择适当的手术方式 。

Objective To study presurgical evaluation and surgical treatment of medically refractory epilepsy.Methods In 17 patients with medically refractory epilepsy,the clinical manifestation showed simple partial seizure in 4 cases,general tonic-clonic seizure(GTCS)secondary to simple partial seizure in 4 cases,GTCS in 2 cases,complex partial seizure in 3 cases,GTCS secondary to complex partial seizure in 3 cases,absence seizure with GTCS in one case.Before the operation all the patients received EEG examination and CT-MRI scanning.In these patients,anterior temporal lobectomy(including most part of the hippocampus and amygdalae)was performed in 4 patients,cortical resection in 12,frontalobectomy in 1.Results Satisfactory outcome was achieved in 5 patients,excellent in 8,good effect rate in 2,bad effect in 1,no effect in 1.The overall good effect rate was 88.2%.Conclusion Surgery was a effective way to treat refractory epilepsy.The key was the location of epileptogenic zone and the selection of surgery.