改良功能性大脑半球切除术治疗婴儿偏瘫伴顽固性癫疒间(附9例分析)

Modified functional hemispherectomy for infantile hemiplegia with intractable epilepsy: analysis of 9 cases

目的探讨改良功能性大脑半球切除术治疗婴儿偏瘫伴顽固性癫疒间的疗效。方法总结9例小骨窗经侧裂功能性大脑半球切除术病人的临床资料。手术均采用侧裂表面4cm×5cm骨窗开颅,分开侧裂后经皮质进入侧脑室,完成功能性大脑半球切除手术。结果与常规功能性大脑半球切除术相比,手术时间明显缩短(平均4.2h)、术中需要输血比例(22.2%)降低。随访时间平均2.1年,Engel癫疒间疗效分级Ⅰ级6例,Ⅱ级2例,Ⅲ级1例。偏瘫改善6例(66.7%),语言改善5例(55.6%),行为改善8例(88.9%)。结论小骨窗经侧裂功能性大脑半球切除术,癫疒间控制效果满意,且可缩短手术时间,减少术中出血。

Objective To evaluate therapeutic efficacy of modified functional hemispherectomy for infantile hemiplegia with intractable epilepsy. Methods The experience with 9 patients treated by hemispherectomy via transsylvian approach was summarized. A craniotomy with the size of 4 cm × 5 cm was placed at the site which corresponds to the sylvian fissure, the circular sulcus was exposed allowing transcortial exposure of the entire ventricular system, thus achieving the functional hemispherectomy. Results The operating time was shorter （averaged 4.2 h） and the proportion of need for blood transfusion （22.2%） was lower as compared with routine fimctional hemispherectomy. The mean follow-up time was 2.1 year, with Engel Ⅰin 6 cases, Engel Ⅱ in 2, and Engel Ⅲ in 1. The hemiplegia was improved in 6 cases （66.7%）, language improved in 5 （55.6%）, and behavior improved in 8 （88.9%）. Conclusion Functional hemispherectomy via transsylvian approach has been demonstrated to shorten operative time and reduce bleeding with satisfying seizure relief.