顽固性癫痫外科手术治疗(附240例报告)

Surgical treatment of intractable epilepsy: report of 240 cases

目的总结癫痫开颅手术的癫痫灶定位及治疗情况，提供手术治疗的结果与经验。方法回顾性分析2001年7月至2004年6月在我院行开颅手术治疗的顽固性癫痫病例240例，总结这些病例的发病特征、定位技术、癫痫灶位置、手术治疗方法以及1年期的随访情况。结果手术结果EngelⅠ级175例，Ⅱ级32例，Ⅲ级20例，Ⅳ13例。术后出现早期癫痫发作91例（占37．9％），硬膜外血肿4例，一过性语言功能障碍17例，一过性一侧肢体力弱23例，远期并发症4例，无死亡病例；智商下降13．4％（20／149），智商提高27．5％（41／149）。结论癫痫外科手术效果较好，有86.3％的患者可以达到EngleⅠ～Ⅱ级的预后，其中以小儿癫痫、病程在3年以内、有局灶性结构异常者效果最好，而只要手术能选择合理的方案，预后与病灶的位置关系不大。

Objective To report the localization and craniotomy treatment of intractable epilepsy, and provide surgical results and experience. Methods A total of 240 cases who were performed epileptic operation in our department from July 2001 to June 2004 were analyzed retrospectively, and the outbreak characteristics, localization techniques, the position of epileptogenic zone, operative methods and surgical results with 1 year of follow-up were summarized. Results Surgical outcomes included 175 cases of Engle grade Ⅰ, 32 cases of grade Ⅱ, 20 cases of grade Ⅲ, and 13 cases of grade Ⅳ. There were 91 （37. 9% ） cases of acute postoperative seizures, 4 cases of extradural hemotoma, 17 cases of transient aphasia, 23 cases of transient hemiplegia, 4 cases of late complications and no death case. IQ improved in 27.5% （41/149） of cases and deceased in 13.4% （23/149） of cases. Conclusion Epileptic operation has satisfactory results, 86. 3% of cases may reach the prognosis of Engle grade Ⅰ to grade Ⅱ, and operation benefits especially for patients of children, with less than 3 years of course and with local abnormal structures. The prognosis has no obvious relationship with the location of epileptogenic zone if the rational surgical project is selected.