癫痫再次手术的探讨和启示

Investigation and enlightenment of reoperation for recurrent epilepsy

目的探讨癫痫患者手术后无缓解或缓解一段时间后症状再次加重的原因以及再次手术的预后,为再次手术的术前评估和手术方法选择提供经验。方法对13例顽固性癫痫患者进行二次手术,其中11例初次手术后缓解一段时间后复发。再次手术主要采用皮层电极监测下癫痫灶切除,对于功能区采用软膜下热灼或多处软膜下横切的方法。再次手术前进行严格的术前评估,术中采用皮层脑电监测。术后口服抗癫痫药物至少1年。随访至少2年。结果9例患者二次手术后取得了良好效果,4例患者完全缓解。结论再次手术前应结合脑电、影像学以及初次手术的病理结果进行严格筛选,术中对癫痫灶进行彻底处理。

Objective To probe into the causes that patients with intractable epilepsy had a uncomfortable results after surgery and to provide experiences for preparation of reoperation and surgical treatments for recurrent epilepsy. Methods A total of 13 cases with recurrent epilepsy underwent reoperation based on the first surgical experiences and comprehensive evaluations. The reoperations mainly eliminated the epileptogenic areas supervised by the electrocorticography. The functional zones were treated by multiple subpial transection or bipolar coagulation. The anti-epileptic drugs were administrated for at least 1 year. And the patients were followed-up for mere than 2 years. Results Nine cases got good outcome after reoperation, including 4 patients avoid of seizure. Conclusion The preparation of reoperation includes not only the outcome of neuroelectrophysiology and neuroimaging, but also the outcome of the first operationg pathology. The surgical treatments for the patients with refractory epilepsy comprise the resection of epileptic foci and the elimination of epileptogenic areas.