难治性癫痫致痫灶定位和手术治疗

Positioning of Epilepsy Seizures Foci and Surgical Treatment of Refractory Epilepsy

目的探讨难治性癫痫致痫灶定位方法和手术治疗效果。方法应用脑电生理、MRI、PETCT等方法对致痫灶综合定位,多种术式处理致痫灶和/或相应传导通路,并评价其疗效。结果75例病人通过多种方法定位,单纯病灶切除23例,前颞叶切除5例,颞叶切除+海马切除12例,选择性海马切除8例,病灶(或脑叶)切除+胼胝体切开5例,病灶切除+软膜横行纤维热凝8例,单纯软膜横行纤维热凝3例,单纯胼胝体切开10例,迷走神经刺激术1例等。术后发作完全消失或1～2次/年30例(40%),发作减少75%22例(29.33%),发作减少50%14例(18.66%),发作减少25%～50%6例(8%),发作减少<25%3例(4%)。结论多种方法联合应用可以对致痫灶精确定位,应用手术方法处理致痫灶或/和相应传导通路可以取得较好的效果。

Objective To explore the location methods of epilepsy seizures and effective surgical treatment for refractory epilepsy. Methods The epilepsy seizures were located by the detection of EEG(depth electrode EEGs, subdural electrode ECoG and ECoG during operation), MRI and PET-CT. Surgical proceduces were under taken to manage the epileptic lesions or conductive ways. The therapeutic effects were followed up. Results In 75 operative patients lesionectomy was performed in 23 cases,temporal lobectomy in 5 cases,temporal lobectomy plus hippo- campectomy in 12 cases, selective hippocampectomy in 8 cases, lesionectomy(lobectomy) plus corpus callosotomy in 5 cases, corpus callosotomy in 8 cases, lesionectomy(lobectomy) plus cortex thermocoagulation in 3 cases, cortex thermocoagulation in 10 cases, and vagus nerve stimulation in 1 case. The total effective rate was 91% with 72% excellence. Conclusion Positioning of epilepsy seizures foci can be precisely mapped by a combination of different diagnostic modalities such as EEG, MRI and PET-CT. Good effects could be obtained by surgical treatment for refractory epilepsy.