顽固性癫痫的术前定位及综合手术治疗

Preoperative Localization of Epileptic Foci and Comprehensive Surgical Treatment of Intractable Epilepsy

目的研究顽固性癫痫的术前定位及将几种手术方式联合应用治疗顽固性癫痫的疗效。方法应用三维痫灶定位诊疗计划对50例顽固性癫痫病人进行术前、术中致痫灶三维精确定位,然后在显微镜下采用几种术式结合的方法手术处理致痫灶、致痫网。术后随访1～2年。结果术中64导皮层电极及8导深部电极检测证实三维痫灶精确定位诊疗计划系统定位准确可靠。术后随访显示22例(44%,22/50)癫痫发作完全消失;18例(36%,18/50)癫痫发作显著减少,效果良好;7例(14%,3/50)疗效差;无明显改善3例(6%,3/50),手术总有效率达80.0%(40/50)。结论选择三维痫灶精确定位诊疗计划和适当的手术方式治疗顽固性癫痫,可以取得最佳的治疗效果。

Objective To study the localization of epileptic foci before the operation and therapeutic effect of comprehensive surgery on intractable epilepsy. Methods The epileptic foci were accccurately localized by 3-dimensional localization system in 50 patients with intractable epilepsy localization before and during the surgery. The isolated epileptic foci and their network were treated by comprehensive surgery consisting of multiple patterns operation. All the patients were followed up for 2-3 years after the operation. Results The accuracy in localization of the epilepsy foci by this 3-dimensional localization system was confirmed by 64-channel electrocorticogram and 8-channel deep electrodes during the operations. The postoperative following up showed that seizure stopped completely in 22 patients（44%）, obviously decreased in 18 （36%）, slightly decreased in 7 （14%） and was unchanged in 3 （6%）. The effective rate was 80%（40/50）. Conclusion If 3-dimensional precise location of the epileptic foci is performed before the operation, the curative effect of the comprehensive surgery on the intractable epilepsy is very good.