脑电监测联合术式治疗难治性癫痫的临床研究

Combined Operation for Patients with Intractable Epilepsy under the Electrocorticogram Monitoring

目的探讨脑电监测下联合手术方式治疗难治性癫痫的方法及其疗效。方法对58例难治性癫痫患者,根据其临床发作类型、体征、EEG、VEEG、CT、MRI、SPECT、认知量表进行术前评估,分别应用以下6种手术方式:①病灶切除术+变性脑组织切除术+MST+胼胝体切开术+前颞叶切除术+选择性海马杏仁核切除术+颅狭征浮动骨瓣整复术1例。②病灶切除术+变性组织切除术+选择性胼胝体切开术+MST4例。③病灶切除术+变性组织切除术+前颞叶切除术+海马杏仁核切除术+MST15例。④病灶切除术+变性组织切除术+MST+热灼术32例。⑤MST+热灼术+选择性胼胝体切开术5例。⑥MST+热灼术+双侧海马、杏仁核放射治疗术1例。结果随诊6个月～11年,根据1996年Engel疗效分级标准:Ⅰ级为26例、Ⅱ级为6例、Ⅲ级为20例、Ⅳ级为6例。Ⅰ级、Ⅱ级32例为临床治愈,Ⅲ级20例为好转,治愈率为55.2%,治愈好转率为89.7%。随访到31例患者智商与术前相比(t=2.706,P=0.011,P<0.05)有不同程度改善。结论根据癫痫放电区域,联合应用多种手术方式给以外科干预,可以收到较好的效果,同时可以不同程度改善脑认知功能。

Objective To investigate effect of combined operations for epilepsy.Methods 58 patients with intractable epilepsy were examined by electroencephologram（EEG）,View EEG,CT,magnetic resonance imaging（MRI） and single photon emission computed tomography（SPECT）.operatative methods were made by clinical sign and examining conclusions.①affection resection,denaturation constitution resection,callosotomy,anterior temple lobe resection,select hippocampus apricot kernel resection,multiple subpial transection and boneplasty in 1 case;②affection resection,denaturation constitution resection,callosotomy and multiple subpial transection in 4 cases;③affection resection,denaturation constitution resection,anterior temple lobe resection,select hippocampus apricot kernel resection and multiple subpial transection in 15 cases;④affection resection,denaturation constitution resection,multiple subpial transection and heat treatment in 32 cases;⑤multiple subpial transection,heat treatment and callosotomy in 5 cases;⑥multiple subpial transaction,heat treatment,callosotomy and both hippocampus apricot kernel radiate treatment in 1 case.Results All patients were followed up from 0.5 to 11 years.Engel standard：Ⅰ26 case,Ⅱ 6 case,Ⅲ 20 case,Ⅳ 6 case.Intelligence quotient were improved in these patients post operation.Conclusion Combined operation was an effective and safe method for intractable epilepsy.