多处软脑膜下横切术治疗顽固性癫痫

Multiple subpial transection in surgical treatment of intractable epilepsy

目的提高顽固性癫痫手术疗效。方法对１９９１年１月至１９９６年１２月实施多处软脑膜下横切除（ＭＳＴ）的１１６例患者的发作类型、病因及手术方法进行分析。结果随访１～５年者１００例，发作完全控制６２例，发作减少７５％以上２０例，发作减少５０％以上１２例（占１２％），无变化６例。总有效率为９４％，显效率８２％，未发现任何功能损害。结论ＭＳＴ治疗顽固性癫痫十分有效，可替代某些传统的痫灶切除术；双额叶ＭＳＴ配合胼胝体前部切开术可作为治疗全身性顽固性癫痫的尝试性手段；手术方法的改良可明显提高手术效果并减少并发症的产生；对于远离功能区的器质性病变应尽量予以切除。

Objective To increase the effect of epilepsy surgery, we use multiple subpial transection (MST) clinically on the basis of experimental study. Method We analized the seizure type and caurse of 116 intractable epilepsy patients treated with MST and surgical technique were modified. Result 100 patients were followed up for 1 to 5 years. Complete contral of seizure was obtained in 62 patients (62 %), significant reduction (over 75 %) in 20 (20 %), reduction (over 50%) in 12 (12%),and no change in 6 (6 %). The total effective rate was 94 %, and the significant effective rate was 82%. No functional defect was found in any patients. Conclusion MST is a effective in surgical treatment of intractable epilepsy and can replace conventional methods.Combined bilateral frontal lobe MST and anterior callosotomy is a good way to treat intractable generalized epilepsy.