软脑膜下多处横切术治疗顽固性功能区癫痫的临床初步报告

Clinical Application of Multiple Subpial Transection for the Treatment of Intractable Focal Epilepsy

对12例顽固性功能区局灶癫痫实施了软脑膜下多处横切术,其中痫灶累及运动区者8例,感觉区3例,Broca’s 区4例,Wernicke’s 区4例,枕叶视皮层2例。手术结果:发作消失8例,占66.7%;减少75%以上2例;减少50%～75%者1例;1例无变化;总有效率91.7%。均无术后功能损害,2例做了手术前后神经心理学检查,均有不同程度改善。本文对手术机理和方法做了较为详细的探讨,认为术前精确定位和术中彻底处理痫是提高手术疗效的关键。

Multiple Subpial Transection(MST)was applied in 12 patients whose epileptigenic lesion involved functional areas.In most of the patients,two or more than two functional areas were involved.MST was applied to the precentral gyrus in 8 patients,postcentral gyrus in 3,Broca's area in 4,Wernicke's area-in 4,and visual cortex in 2.Complete control of seizures was obtained in 8 patients(66.7%),significant reduction(more than 75%)of seizure in 2,reduction between 50% and 75% in 1 and no change in 1.The Total effective rate was 91.7%.No functional impairment occured and some improvement was found in 2 patients at neuropsychological examinations. Mechanism and surgical technique were explained in detail.The MST unit was designed by the authors themselves.The outcome of operation was analysed.It suggests that precise localization and radical management of the epileptigenic lesion is most important to the increase of the curative effect of MST.