不伴有结构性病变药物难治性癫痫外科治疗

Surgical treatment of intractable epilepsies without structural lesions

目的对不伴有结构性病变药物难治性癫痫进行外科治疗回顾性分析,探讨术前癫痫灶定位,术中皮层电极监测下癫痫手术方式选择,以及术后癫痫控制的意义。方法头MRI扫描未见有结构性病变的药物难治性癫痫患者99例,均为复杂部分发作,其中继发全身强直-阵挛发作57例,术前24h视频脑电图(V-EEG)监测,专业评估系统详细全面评估,进行癫痫灶定位,术中皮层电极监测下联合运用前颞叶切除,额极切除,功能区软膜下多处横切术或(和)低功率热灼术,切除癫痫灶或阻断痫性放电传播的途径。结果术后按照Engel疗效判断标准:EngelⅠ级40例,EngelⅡ级46例,EngelⅢ级8例,EngelⅣ级5例。结论对不伴有结构性病变药物难治性癫痫,术前V-EEG结合临床表现,专业评估系统进行全面评估定位癫痫灶,术中皮层电极监测指导下联合不同癫痫手术方式可获得较好疗效。

Objective To evaluate the role of preoperative epileptogenic zone localization and selection of surgical procedure by electrocorticography（ECoG） monitoring in operation of intractable epilepsies without structural lesions.Methods 99 patients with pharmacoresistant epilepsy without distinct lesions on magnetic resonance images（MRI） were complex partial seizure.57of them were secondary generalized Tonic-clonic seizures.the epileptogenic zone of all cases were located by means of preoperative 24 hours video-EEG and comprehensive professional presurgical assessment.Epileptogenic foci resection or block epileptic foci discharge channels was obtained by combitation of anterior temporal lobectomy,frontal pole lobectomy,and subpial multiple transection（SMT） and（or） purely electro-coagulation in functional areas acording to accurate intraoperative electrocorticography（ECoG） evaluation.Results The postoperative effects acording to Engel′s standard were grade I in 40 cases,gradeⅡin 46 cases,gradeⅢin 8 cases,and grade Ⅳin 5 cases.Conclusion After accurate location of epileptogenic zone using preoperative 24 hours video-EEG and comprehensive professional assessment systems,combitation of mutiple epileptic surgical procedures acording to intraoperative electrocorticography（ECoG） can result in significant improvements in seizure control for intractable epilepsies without structural lesions.