多脑叶切除治疗半球顽固性癫痫临床观察

A Clinical Study of Multi-lobe Resection in Treatment of Hemispheric Intractable Epilepsy

目的探讨多脑叶切除治疗半球顽固性癫痫的规范化程序及效果。方法对14例半球顽固性癫痫的临床表现及术前多种脑电图和神经影像学等检查结果进行综合分析,定位癫痫灶。对以单侧半球为主的弥漫性或多发性癫痫灶采用两个脑叶以上切除及联合软膜下横切等手术方式进行治疗:①前颞叶切除+海马及杏仁核切除+额极切除4例;②前颞叶切除+海马及杏仁核切除+枕极切除1例;③前颞叶切除+额极切除+胼胝体前2/3切开+额、颞、顶枕部软膜下横切(MST)3例;④颞前叶切除+枕极切除+胼胝体后1/2切开2例;⑤前颞叶切除+额极切除+额、颞、顶部MST 2例;⑥前颞叶切除+枕极切除+顶枕部非功能区皮质结节性病变切除及周围MST 1例;⑦改良大脑半球切除1例。结果本组术后癫痫发作完全消失、无先兆9例(64.29%),其中4例已停服抗癫痫药;仅有先兆,无其他癫痫发作5例(35.71%)。结论多脑叶切除(含改良大脑半球切除术)治疗源于半球多脑叶的顽固性癫痫效果肯定。结合患者的临床症状学、影像学及神经电生理学等方面资料综合分析,术前准确评估和精确定位功能区域,是手术成功的先决条件。

Objective To discuss the normalized process and curative effect of hemispheric intractable epilepsy patients with multi-lobe resection.Methods Comprehensive analysis of the clinical manifestations of patients,preoperative multiple EEG and imaging examination results were taken and studied.Epileptogenic focus was located and scapular flap and fibular flap were designed.Based on 14 patients with unilateral hemisphere dominated by diffuse or multiple epileptic,we used the methods of resecting more than two brain lobes combined with modus operandi such as subpial transection in treatment： ① 4 patients received resection of prefrontal lobe,hippocampus,amygdale and frontal pole;② 1 patient received resection of anterior temporal lobe,hippocampus,amygdale and frontal pole;③ 3 patients received resection of anterior temporal lobe,frontal pole,corpus callosum first 2/3 incision and MST;④ 2 patients received resection of anterior temporal,occipital pole and 1/2 incision after the corpus callosum;⑤ 2 patients received resection of anterior temporal lobe,frontal pole and MST;⑥ 1 patient received resection of anterior temporal lobe,occipital pole,parietooccipital cortex of non-functional nodules and MST around;⑦ 1 patient received modified hemispherectomy resection.Results Epileptic seizure completely disappeared and no aura in 9 patients（64.29%）,4 of whom stopped taking anti-epileptic drugs;5 patients（35.71%） only had aura but no other seizures.Conclusion The results of multi-lobe resection（including modified hemispherectomy resection） treatment with hemispheric intractable epilepsy from multi-lobar are obvious.Multi-lobe resection is an optional surgical approach,but further comprehensive analysis combined with the clinical symptomatology,imaging and neural electrophysiology are needed.Accurate preoperative assessment and functional areas of precise positioning is the prerequisite for successful surgery.