症状性癫痫的手术治疗(附19例报告)

Surgery for Symptomatic Epilepsy Induced by Cerebral Lesions (a Report of 19 Cases)

目的探讨脑部病变导致的症状性癫痫的诊断和手术经验。方法对19例症状性癫痫患者进行术前头皮视频脑电图监测和影像学检查,以明确病灶及致痫灶,在术中皮层脑电图监测下进行手术治疗。结果本组无手术死亡病例,术后病检示胶质瘤11例,脑动静脉畸形3例,海绵状血管瘤3例,蛛网膜囊肿1例,蛛网膜囊肿伴颞叶局灶皮质发育不良1例。术后随访6月以上的14例病人按照Engel癫痫疗效分级,Ⅰ级13例(92.86%),Ⅱ级1例(7.14%)。结论癫痫病人应该积极寻找病因,症状性癫痫通过外科治疗可获得满意效果。

Objective To summarize the experience in diagnosing and surgically treating symptomatic epilepsy. Methods MRI and long-term video-electroencephalogram （EEG） examinations were performed before the surgery in 19 patients with symptomatic epilepsy in order to locate the intracranial lesions and epileptogenic zone. One patient received intracranial EEG examination besides MRI and video-EEG. The operations are performed under monitoring by electrocorticogram in 19 patients, of whom, 15 underwent resection of the lesions and epileptogenic cortexes, 2 the resection of lesions and multiple subpial transections, and 2 the resection of lesions and anterior temporal lobectomy. Results No serious complication occurred in all the patients. The histopathological examination showed that of 19 patients, 2 suffered from dysembryoplastic neuroepithelial tumors, 4 from astrocytic tumors of grade Ⅰ - Ⅱ, 2 from oligodendrogliomas, 3 from anaplastic astrocytomas, 3 from cerebral arteriovenous malformations, 3 from cavernous hemangiomas, 1 from arachnocyst, and 1 from arachnocyst accompanied with focal cortical dysplasia. According to Engel classification of curative effect on epilepsy, of 14 patients who were followed up 6 months after the operation, 13 belonged in grade Ⅰ and 1 in grade Ⅱ. Conclusions The patients with epilepsy should be actively examined in order to find the cause of epilepsy. The satisfactory results will be achieved by surgical treatment in the patients with symptomatic epilepsy.