伽玛刀治疗难治性癫痫的临床观察

Gamma Knife Radiosurgery in Management of Intractable Epilepsy

目的探讨伽玛刀治疗症状性难治性癫痫的疗效。方法2003年1月—2007年1月，我院应用国产旋转式立体定向放射系统（伽玛刀）治疗经长期正规药物治疗不能控制的脑内有病灶的难治性癫痫20例。选择靶点：头颅MRI扫描确定病灶部位，并结合脑电图、脑电磁图、PET—CT等检查确定；适当扩展病灶外延1～2mm作为治疗靶点，靶点周边剂量10～13Gy，中心计量为20～26Gy。疗效评估采用国际抗癫痫联盟提出的疗效标准。结果20例患者术后平均随访15个月（3～42个月）。满意3例；显著改善9例；良好5例；效差2例；无效1例。显效率为85％。治疗后症状即开始缓解，治疗后症状稳定平均时间为4．1个月（0～11个月）；未出现并发症。结论伽玛刀治疗难治性癫痫能够显著控制癫痫的发生、提高生活质量，对病灶明确的症状性难治性癫痫是一种较为理想的治疗方法。

Objective To explore the feasibility and the validity of gamma knife radiosurgery for intractable epiIepsy treatment. Methods From Jan. 2003 to Jan. 2007, 20 patients with intractable epilepsy were treated with gamma knife. The foci were located by EEC, CT, MRI and PET-CT. Six patients suffered from cerebral vascular disease, three from glioma, four from cerebral malacia, two from meningioma, two from mesial temporal sclerosis, one form gray matter heterotopia, and two from other diseases. Each epilepsy focus was given isobaric curve coverage of 50% and a peripheral dose of 10 - 13 Gy. Results After gamma knife treatment, 18 of the 20 intractable epilepsy patients were followed up 15months （3 -42 months）. The efficient rate was 85%. Conclusion Gamma knife radiosurgery is one of the effective methods to the treatment of intractable epilepsy.