中央区癫痫的手术治疗及预后分析

A clinical study on surgical treatment for perirolandic epilepsy and the predictor for good outcomes

目的探讨治疗中央区癫痫的手术方法及提示手术预后的相关因素。方法以自2006年10月至2008年3月北京功能神经外科研究所连续收治的21例巾央区癫痫患者为研究对象，行致痫灶切除术。术后随访12个月以上，Engel分级I、Ⅱ级为预后良好，分析与预后良好相关的斟素。结果Engel分级I、Ⅱ级共14例（67％）。MRt可见病变与MRI无病变相比，预后良好率较高（P〈0．05）；病理为局灶性皮质发育不良患者与其他病理患者相比，预后良好率较低（P〈0．05）。结论中央区癫痫经精确定位功能区及致痫灶，行致痫灶切除，总体预后良好。MRI可见病变提示预后良好，病理为局灶性皮质发育不良较其他病理改变预后差。

Objective The purpose of the study was to investigate effective surgical procedure for perirolandic epilepsy and the predictor for good outcomes. Method We collected 21 subjects who underwent epilepsy surgeries consecutively in Beijing Institute of Functional Neurosurgery with the epileptogenic zone located in perirolandic areas from October 2006 to March 2008. Over 12 - month following up and Engel I and Ⅱ taken as ＂good＂ outcomes,we analyzed the predicting factors for good outcomes. Results At the end of follow up,Engel class I and Ⅱ were 14 cases（67% ）. Patients with lesion in MRI obtained better outcomes and patients with focal cortex dysplasia（FCD） pathology obtained worse outcomes regarding the rate of Engel class I ＋Ⅱ（ P 〈0. 05）. There were no serious functional deficits. Conclusions Surgical resection of epileptogenic zone for periroladic epilepsy can aehieve good outcomes. Patients with lesion in MRI predieted better outcomes and FCD pathology predicted worse outcomes.