难治性多灶性癫痫的立体定向手术治疗(附92例临床分析)

Therapeutic effect of stereotactic surgery on refractory epilepsy with multiple epileptic focus

目的探讨立体定向技术对难治性多灶性癫痫的治疗效果。方法 2004年～2009年采用脑电图、MRI、脑磁图(magnetoencephalography,MEG)检查等术前综合评估,对双侧大脑半球均存在多个致痫区、无法进行开颅广泛致痫灶切除手术的难治性癫痫患者92例,采用立体定向技术进行胼胝体两侧、双侧杏仁核、内侧隔区及单侧Forel-H区等多靶点组合射频毁损治疗,手术后对患者进行跟踪随访、评定疗效。结果按照谭启富癫痫疗效分级,本手术对癫痫发作控制的满意率在术后1～5年达62%。结论对无法进行开颅行致痫灶切除手术的难治性多灶性癫痫患者,立体定向手术是一种较好的治疗手段。

Objective To explore the therapeutic effect of stereotactic surgery on patients of refractory epilepsy with multiple epileptic focus.Methods From year 2004 to 2009,92 patients of refractory epilepsy with multiple epileptic focus were diagnosed by electroencephalogram（EEG）,magnetic resonance image（MRI） and magnetoencephalography（MEG）.These patients were treated by stereotactic techniques,multi-nucleus lesion by radio-frequency equipment.The therapeutic effect was evaluated during the follow-up.Results One year to five years later,according to Tan Qifu＇s standard of curative effect,the percent of gratification reached 62% among the operated patients every year.Conclusion For the patients of refractory epilepsy with multiple epileptic focus,the lesion of bilateral corpus callosum,bilateral amygdala,bilateral medial septal area and unilateral Forel-H area might be an effective treatment method.