手术治疗Rasmussen's脑炎的早期疗效观察

The early outcome of Rasmussen's encephalitis after surgical treatment

目的总结手术治疗Rasmussen’s脑炎的早期疗效。方法回顾性分析9例患者的临床资料并系统随访10-30个月。结果经过综合评估,6例行大脑半球切除术,2例行颅内电极脑电图监测后"tailor"式切除联合功能区致痫皮质电凝热灼术,1例行多脑叶切除术。在随访期间,癫痫发作完全消失者3例、偶有发作者2例、发作减轻者3例、1例无缓解。术后早期5例出现肌力下降、4例无变化。经过康复治疗后,肢体功能好转6例,神经心理功能改善8例。结论手术治疗Rasmussen’s脑炎,不仅能有效控制或减轻癫痫发作,还能改善患者的神经心理功能。其早期疗效值得肯定。

Objective Presenting of 9 cases with Rasmussen＇ s encephalitis being surgically treated, to observe the early clinical effects after 10 to 30 months follow-up. Methods We retrospectively analyze the clinical data of 9 cases with Rasmussen＇s encephalitis. Different operations had been made based on the pre-operation evaluations, including the clinical semiologies, MRI scans, PET, V-EEG and Wada Test information, and regular follow-up was made. Results 4 cases in the prodromal phase, 4 cases in the acute phase and 1 case in the residual phase were surgically treated. 6 cases were operated with hemispherectomy （2 cases with Adame＇s Modified and 4 case with Rasmussen＇s Modified ） and 3 cases with selectively epileptogenic zone resection combining with Bipolar Electro-coagulation on Functional Cortexes （BEFC） based on the intracranial Grid electrode implantation and EEG monitoring. 5 cases had immediate cessation of seizures （ Engel class Ⅰ and Ib ） , 2 cases with alleviation of seizures （ Engel class Ⅱ ） , 1 cases with Engel class Ⅲ and Ⅰ with Engel class IV after operation, 4 cases had a early contralateral hemiparesis, 1 case had a weaker extremities strengths than before and 4 cases with no changes of muscle strength. 6 cases with hemiparesis had a significant improvements during 10 to 30 months follow-up and 8 patients had a significant meliorate in neurological and social functions. Conclusion Rasmussen＇s encephalitis is a drugresistant epilepsy syndromes accompanied by progressive neurological deterioration. Hemispherectomy is a viable alternative, which should be considered in the treatment of Rasmussen＇s encephalitis based on the pre-evaluations.