Lennox-Gastaut综合征的外科治疗初探

Preliminary investigation on surgery of Lennox-Gastaut syndrome

目的：探讨采用联合多种术式治疗顽固性Lennox-Gastaut综合征（LGS）的手术效果。方法：回顾性总结、分析采用小范围（多）脑叶（极）切除联合多软膜下横纤维切断术（MST）和胼胝体切开术所治疗的12例顽固性LGS患者。结果：本组术后随访1～3年,平均2年。疗效按Engel的标准进行评定,12例患者中有5例获得Ⅰ级,3例获得Ⅱ级,2例为Ⅲ级,仅2例为Ⅳ级;平均总智商（FIQ）从术前的62.8分提高到72.9分。除枕极切除的患者术后出现对侧视野同向偏盲外,余无严重并发症。结论：采用这种联合（多）脑叶（极）切除、MST和胼胝体切开的方法来治疗部分以单侧半球痫样放电为优势的LGS患者,可较好地控制患者的癫痫（EP）发作,并改善其智力损害。

Objective To explore the effect of surgical intervention in Lennox-Gastaut syndrome （LGS）. Methods The results of 12 Lennox-Gastaut syndrome patients who underwent focal multilobar resection in combination with multiple subpial transaction （MST） and corpus callosotomy were reviewed. Results All patients were followed up 1 to 3 years （average of 2 years）. Of 12 patients, 5 obtained Engel Class I after surgery, and an additional three patients presented rare seizure （Engel Class Ⅱ）. Two patients showed a significant decrease in seizure frequency （Engel Class Ⅲ）, and unchanged in two patients （Engel Class Ⅳ）. The mean FIQ increased from 62. 8 to 72. 9. No severe complication occurred except that 4 patients underwent occipital pole resection demonstrated contralateral hemianopia. Conclusion Focal muhilobar resection combined with MST and corpus callosotomy results in a favorable outcome in Lennox-Gastaut syndrome with hemispheric-dominant discharge, and demonstrates improvement in seizure control and intelligence protection.