外伤后癫痫致痫灶定位和术式选择的临床观察

Location of epileptogenic focus and selection of appropriate surgical methods in treatment of post-traumatic epilepsy

目的评价多种手术方法联合使用治疗外伤后癫痫的效果。方法21例患者根据术前致痫灶的初步定位和术中皮层脑电及深部电极的监测结果,分别采用以下5种不同的术式:⑴疤痕及周围皮层切除7例;⑵疤痕及周围皮层切除+多软膜下横切术(MST)8例;⑶前颞叶、杏仁核-海马切除4例;⑷神经导航下选择性杏仁核-海马切除1例;⑸胼胝体前部切开+MST+皮层热灼1例。结果术后随访3个月至10年,疗效满意的9例(42.9%),显著改善的7例(33.3%),良好的3例(14.3%),效差的1例(4.8%),无改善的1例(4.8%)。术后无死亡病例,有8例出现暂时性的功能障碍,但均在4周内恢复正常。结论多种手术方法联合治疗外伤后癫痫安全有效。

Objective To evaluate the efficacy of combined various surgical procedures for the treatment of post-traumatic epilepsy. Methods According to the preoperative primary location of epileptogenic focus and the monitoring results of intraoperative electrocorticography and depth electrodes, 21 seizure patients were treated with various surgical procedures： 7 cases with epileptogenic focus resection, 8 cases with epileptogenic focus resection combined with multiple suhpial transection （MST） ,4 cases with anterior temporal lobectomy combined with amygdalo-hippocampotomy, 1 case with selective amygdalo-hippocampotomy under neuronavigation,and 1 case with anterior callosotomy combined with MST and bipolar coagulation on funtional cortexes. Results All the patients were followed up from 3 months to 10 years postoperatively, and the surgical outcomes were such as the followings： satisfactory outcome in 9 cases （42. 9% ） ,marked improvement in 7 cases （33.3%） ,improvement in 3 cases （ 14. 3% ）, slight improvement in 1 case （4. 8% ） and no improvement in lease （4. 8% ）. There was no died cases caused by the surgical procedures. Eight patients had temporary dysfunction after operation, but all recovered in four weeks after surgery. Cmldusion The combined various surgical procedures are effective and safe for the treatment of post-traumatic epilepsy.