多处软膜下横切术结合其它术式治疗顽固性癫痫

New considerations of treating intractable epilepsy with multiple subpial transection in combination with other operations

目的探讨多处软膜下核切术（ＭＳＴ）结合病灶切除或脑叶切除对顽固性癫痫的治疗。方法术前借助影像学和脑电图定位，术中皮层脑电图地毯式探查，对非功能区病灶予以切除，其周围行ＭＳＴ直至痫波消失；对无明显病灶，广泛脑电异常还涉及颞叶者，特别是探查到杏仁核区及海马区有痫波者，除行ＭＳＴ外还要切除前颞叶（包括杏仁核及海马）；对于重要功能区有痛波者行ＭＳＴ，如果其中有明确的占位病变同时行ＣＴ立体定向导引下占位病变切除术。术后抗痫药治疗２年逐渐减量或停药。结果本组１１例无手术死亡和严重并发症。仅２例术后数天内有一侧肢体肌力下降，但很快恢复正常。随访１～５年，９例无癫痫发作，２例在１１年内尚有小发作；脑电图复查癫痫波消失，或原广泛中重度脑电异常改变为小范围轻度异常。结论ＭＳＴ结合病灶切除或脑叶切除对顽固性癫痫治疗能保留更多正常脑组织和取得更好的疗效。

Objective To evaluate the effect of multiple subpial transection (MTS) in combination with resection of epileptogenic' focus or lobectomy on intractable epilepsy. Methods Epileptogenic focus was diStinguished by the aid oLdiagnostic imaging andelectroencephalography. Electrocorticography was done in a cadet-model during operation. Epileptogenic focus located in 'nonfunctional' cortex was resected and MST was done around the focus until epileptic waves disappeared on the electrocorticogram. Thepatients who had no obvious epileptogenic focus but had extensive abnormal waves especially in the temporal lobe, amygdaloidnucleus or hippocampial areas, underwent anterior temporal lobectomy including selective amygdalo-h ippocampecto my in additi onto MST MST was administered to the important functional cortex with epileptogenic waves along with stereotactic cerebraloperation by CT if there was space-occupying lesion in the cortex. All patients received anti-epileptic drugs for 2 years during whichthe drug doses were gradually reduced. Results No death and severe complication after the treatmeflt occurred in the 11 patients.Only 2 patients suffered hemiplegia in several days after treatment and recovered quickly. All the patients were followed up one tofive years. Nine patients had no epileptic attack after operation and only 2 had petit mal epilepsy in one year after operation. Followup electroencephalography showed that the epileptic waves disappeared or the eXtensive and moderately or severely abnormal waveschanged into local and mildly abnormal waves. Conclusion MST in combination with resection ofepileptogenic focus or lobectomyfor intramable epilepsy could remain more normal cortex and obtain biber outCome.