创伤性癫痫致痫灶的定位及手术治疗

Localization and microsurgical management of epileptogenic nidus of traumatic epilepsy

目的 探讨创伤性癫痫致痫灶的定位及手术治疗效果.方法 对2005年11月-2009年5月手术治疗的62例创伤性癫痫患者进行回顾性分析.其中男48例,女14例;年龄11-48岁,平均28.8岁.根据临床表现、警醒状态下脑电图（V-EEG）及电生理学检查结果进行术前定位59例,通过颅内电极置入定位3例.在皮层脑电图（ECoG）监测下根据不同情况采用单纯软化灶切除术36例,软化灶及周围痫样放电部位一并切除15例,软化灶部分切除联合低功率皮层热灼术11例.结果 术后随访6～33个月,按Engel分级：Ⅰ级32例,Ⅱ级17例,Ⅲ级9例,Ⅳ级4例,无Ⅴ级患者.结论 V-EEG是创伤性癫痫致痫灶术前定位的重要检查手段.在ECoG监测下进行手术,疗效满意.

Objective To investigate the localization and surgical outcome of epileptogenic nidus of post-traumatic epilepsy. Methods A retrospective analysis was performed on clinical data of 62 patients with post-traumatic epilepsy treated microsurgicallly from November 2005 to May 2009. There were 48 males and 14 females, at age range from 11 to 48 years old （average 28.8 years old）. The epileptogenic nidus in 59 patients was localized based on clinical manifestations, visual electroencephalography （V-EEC） imaging and electrophysiological findings and that in three patients localized by implanted intracranial electrodes. Under electrocorticogram （ECoG） monitoring, we resected cerebral malacia in 36 patients, removed both malacia and epileptogenic nidus in 15, and partially resected cerebral malacia combined with cortex thermocoagulation in 11. Results The follow-up for 6-33 months showed that there were 32 patients at grade Ⅰ , 17 at grade Ⅱ , nine at grade Ⅲ and four at grade Ⅳ according to Engel classification system. Conclusion V-EEG is an important method for pre-operative localization of epileptogenic nidus of post-traumatic epilepsy. Microsurgical management can attain favorable outcome under ECoG monitoring.