手术治疗多癫痫灶的难治性癫痫65例

Surgical treatment on patients with multiple focus of refractory epilepsy 65 case

目的:探讨难治性癫痫外科干预多癫痫灶的方法和运用该方法所达到的手术疗效。方法:对65例难治性癫痫患者,根据其临床发作类型、体征、脑电图(electroencephalogram,EEG)、视频脑电图(vedio electroencephalogram,VEEG)、计算机体层摄影(computed tomography,CT)、磁共振成像(muclear magnetic resonance,MRI)、单光子计算机体层摄影(single-photon emissiontomography,SPECT)、认知量表进行术前评估,分别应用以下6种手术方式:(1)病灶切除术+变性脑组织切除术+多处软脑膜下横纤维切断术(multiple subpial transaction,MST)+胼胝体切开术+前颞叶切除术+选择性海马杏仁核切除术+颅狭征浮动骨瓣整复术1例;(2)病灶切除术+变性组织切除术+MST+热灼术36例;(3)MST+热灼术+选择性胼胝体切开术5例;(4)MST+热灼术+双侧海马、杏仁核放射治疗术1例;(5)病灶切除术+变性组织切除术+选择性胼胝体切开术+MST 4例;(6)病灶切除术+变性组织切除术+前颞叶切除术+海马杏仁核切除术+MST 18例。结果:随诊6个月至11年,根据Engel疗效分级标准:Ⅰ级30例,Ⅱ级9例,Ⅲ级20例,Ⅳ级6例。Ⅰ、Ⅱ级39例为临床治愈,Ⅲ级20例为好转,治愈率60.00%,好转率90.77%。随诊38例患者智商有不同程度改善。结论:多癫痫灶难治性癫痫外科干预,根据癫痫放电区域的不同,应用不同的手术方式,可以收到较好的效果。

Objective：examing the methods employed in surgical treatment aiming at curing refractory epilepsy by intervening and the effects such methods intend to achieve.Methods：On the basis of the relative data concerning 65 patients with refractory epilepsy collected through the means of electroencephalogram or EEG,video EEG,CT,single photon emission computed tomography or SPECT,magnetic resonance imaging or MRI,and through assessing their cognitive capacity before their treatments,6 methods were employed respectively.These methods are：resecting the affected area,degenerative brain tissues,and anterior temple lobe,removing hippocampus apricot kernel in a selective way,transecting callosotomy,and craniostenosis restitution opration while using the means of multiple subpial transection（hereafter referred to as MST） in actual operation（the method was employed in one case）;resecting affected area and denaturation constitution degenerative brain tissues while using the means of MST and heat treatment in operations（the method was employed in 36 cases）;making use of the means MST combined with heat treatment while transecting callosotomy in a selective way in operations（the method was employed in 5 cases）;;radiate treatment on both hippocampus apricot kernel combined with the means of MST and heat treatment（the method was employed in 1 case）;resecting affected area and denaturation constitution,transecting callosotomy in a selective way combined with the means of MST（the method was employed in 4 cases）;resecting affected area,denaturation constitution,anterior temple lobe and hippocampus apricot kernel while using MST（the method was employed in 18 cases）.Results：After relative treatments patients were followed up with the length of the follow-up ranging from 6 months to 11 years and judged by the Engel standard 26 of them could reach the level of Ⅰ,and 9 of them could reach the level of Ⅱ,all recovering completely;besides,20 of those patients could reach the level of Ⅲ,recovering well,and 6 of those patient who were followed up could reach the level of Ⅳ,which suggests that the ratio for total recovery could reach to 60.00% and the ratio for ideal recovery could amount to 90.77% and all those patients have demonstrated the sigh of getting better in terms of their intelligence.Conclusions：When dealing with refractory epilepsy concerning multiple focus of refractory epilepsy in surgical treatment,ideal and effective results could realized by employing appropriate but different surgical methods based on the different areas in epilepsy electroencephalogram.