改良大脑半球切除术对不同病理基础患者的疗效分析

Therapeutic effect of modified hemispherectomy on patients with different pathologic bases.

目的探讨改良大脑半球切除患者术后癫痫控制和发育、运动及语言功能与病理基础间的关系。方法对12例行改良大脑半球切除术患者的临床资料、术后癫痫控制、发育、运动及语言功能等进行比较。其中6例半侧巨脑畸形（HME）。4例梗影缺血。2例Rasmussen脑炎（Rasmussen encephalitis，RE）。采用韦氏量表对12例患者术前度术后IQ进行评估。结果HME组癫痫始发年龄最小；术前各病理组癫痫发作频率没有差别；HME组患者运动、语言功能较差。发育迟缓表现更突出。术后10例癫痫获得完全控制，余2例HME患者发作减少75％以上。HME患者术后发育改善较明显。但运动、语言功能改善不够显著。结论改良大脑半球切除术能有效地控制各种病理基础的、病变累及一侧半球的顽固性癫痫。不同病理基础的患者在术后癫痫控制方面差异不明显。HME患者在术前临床资料及术后的神经功能改善方面，与其他组存在一定的差异。

Objective To explore the relationship between postoperative seizure control tdevelopment,language,motor outcomes and the pathologic substrates in patients undergoing modified hemispherectomy. Methods： The difference of clinical data, seizure control, growth,language and motor functions in modified hcmispherectomy patients （ n =12 ） with hemimegalencephaly （ HME ; n =6 ）, infarct/ischemia （ n = 4 ）, and Rasmussen encephalitis （ RE ; n = 2 ） were compared. WISC was used to assess the patients＇ intelligence quotients. Results： HME patients were the youngest at seizure onset. Prior to surgery,there was no obvious difference in seizure onset among the patients of different pathologic substrates; motor and linguistic functions were poorer in HME patients, and they also showed severe developmental delay. All but 2 patients with H ME,also got 〉 75% reduction in seizure onset,were seizure free postoperation. HME patients showed more obvious improvement in development but motor and language function were not improved significantly. Conclusions ： Modified hemispherectomy could effectively control the intractable seizure due to different pathologic substrates involving hemisphere. There is no significant difference in seizure control among different pathologic categories. HME patients have some differences with others in clinical materials and improvements of neurological functions.