外伤性难治性癫痫的显微外科治疗

Micro-surgical treatment of intractable post-traumatic epilepsy

目的探讨外伤性难治性癫痫的临床特征、外科治疗方法及疗效。方法回顾性分析47例外伤性难治性癫痫病例，均采用显微外科手术治疗，术前进行详细的病史采集、影像学、视频脑电图（VEEG）监测评估，术中联合皮层脑电（ECOG）监测和深部电极技术。手术方式包括致痫灶切除术、前颞叶切除术、前颞叶及海马切除术、皮质热灼术。结果术后随访8个月～3年，按照Engel分级，I级27例，Ⅱ级15例，Ⅲ级5例，无Ⅳ级患者。结论术前综合评估、显微外科手术联合皮层脑电监测及深部电极定位治疗外伤性难治性癫痫是有效的方法。

Objective To explore the clinical feature and surgical treatment of intractable post traumatic epi- lepsy （PTE） and its effect. Methods A total of 47 patients with PTE were retrospectively analyzed and micro-sur- gical treatment was adopted in all cases. Detailed history taking,imageology,VEEG monitoring were done before the operation. Electrocorticography（ECOG） and depth electrode were used during the operation. The surgical approa- ches included resection of the epileptogenic foci, anterior temporal lobectomy, resection of anterior temporal lobe and hippocampus,bipolar coagulation of the cortex. Results The follow-up showed that according to Engel＇s grading,27 cases were grade Ⅰ , 15 cases grade Ⅱ , 5 cases grade Ⅲ and no cases were grade Ⅳ within 8 months to 3 years. Surgical treatment was highly recommended in late post-traumatic epilepsy patients if systematic medical treatment failed. Conclusion Detailed preoperative evaluation,micro-surgical treatment with ECOG monitoring and depth electrode are highly recommended in intractable post-traumatic epilepsy patients.