难治性外伤性癫痫的综合手术治疗

Combined Surgical Treatments in Patients with Intractable Posttraumatic Epilepsy

目的：探讨联合应用不同术式治疗难治性外伤性癫痫的手术效果。方法：经术前评估，根据35例难治性外伤性癫痫患者不同特．董，选择适宜的术式联合应用，术中行皮层脑电图监测。术式包括致痫灶切除、前颞叶切除、选择性杏仁核一海马切除、胼胝体前部切开、多处软膜下横纤维切断术等。结果：术后随访6～36个月，按照Engel分级，35例手术患者，Ⅰ级18例，Ⅱ级12例，Ⅲ级5例，无Ⅳ级的患者，有效率85．7％（30／35）。结论：术前认真评估、采用个体化原则、选择适宜的手术方式联合应用、术中行皮层脑电图监测等措施是外科治疗难治性外伤性癫痫获得良好疗效的关键环节。

Objective：To explore the curative effect of the combined operations on patients with intractable posttraumatic epilepsy. Methods：After preoperative evaluation, thirty five patients with intractable posttraumatic epilepsy underwent suitable comprehensive operations under electrocorticogram monitoring according to their clinical features. The comprehensive operation included resection of the epileptogenic focus, anterior temporal lobectomy, selective amygdalo-hippocampectomy, anterior cor- pus callosotomy and multiple subpial transaction. Results：All the patients were followed up from 6 to 36 months. According to Engel＇s grading, among 35 cases, 18 cases were grade Ⅰ , 12 cases were grade Ⅱ , 5 cases were grade Ⅲ , and no cases were grade Ⅳ. The effective rate was 85.7% （30/35）. Conclusions：The satisfactory clinical outcome of the surgical treatment of in- tractable posttraumatie epilepsy could be obtained with the help of exact preoperative evaluation, adopting the principle of indi- viduation, suitable comprehensive operations being performed under electrocortieogram monitoring.