胼胝体全段一期切开治疗癫疒间性脑病

Single-stage total callosotomy for treatment of epileptic encephalopathy

目的探索胼胝体全段一期切开的安全性,观察该术式治疗癫疒间性脑病的有效性。方法回顾性分析我科手术治疗的37例癫疒间性脑病的临床资料。经临床症状学、神经电生理学、神经影像和神经心理学综合评估后,于全麻下额部切口、经前纵裂入路显微镜下一期切开胼胝体全段。依Engel分级标准评判手术效果。结果随访18～34个月,Engel-Ⅰ级3例,Engel-Ⅱ级25例,Engel-Ⅲ级7例,Engel-Ⅳ级2例,手术总有效率达75.7%。跌倒发作、强直发作、痉挛发作和强直-阵挛发作的有效率分别为86.2%、77.5%、61.6%和40.8%。14例患者出现不同程度的手术后并发症,缄默11例、轻偏瘫7例、颅内感染1例。其中13例患者分别在出院时和出院后1月内痊愈,1例患者仍遗留轻偏瘫。结论胼胝体全段一期切开安全、微创,无新发并发症;它能有效减少癫疒间性脑病的癫疒间发作频率、减轻发作程度。

Objective Single-stage total corpus callosotomy（CC） can reduce the seizure freque- ney and severity in patients with epileptic eneephalophathy such as Lennox-Gastaut syndrome （LGS） and West syndrome （WS）. The study is trying to explore the safety of the procedure and observe it＇ s efficacy in controlling the seizure of epileptic encephalophathy. Methods 37 cases with LGS and WS were retrospectively studied, including their seizure semiology, MRI scans, V-EEG data and neuropsychology. The operation was performed under general anesthesia, a curvilinear, right or left- sided incision was made along the coronal sutures and midline of the frontal area, microscope was used to dividing the interhemispheric space and exposing the pericallosal structures and performing the total CC. Postoperative assessment was made in Engel＇ s criteria. Results Postoperative follow-up had been made from 18 to 34 months with 3 cases of Engel-Ⅰ,25 cases of Engel-Ⅱ,7 cases of Engel-Ⅲ and 2 cases of Engel-Ⅳ. The operative efficiency was reached to 75.7% totally and 86.2% ,77.5%, 61.6% and 40.8% in different type of seizure ,including drop attacks ,tonic seizure, spasm and gene- ralized tonic-clonic seizure respectively. Postoperative complications were happened in 14 cases with 11 cases of mutism,7 cases of paralysis and 1 case of infection. Most of the patients were recovered from the transient complications and only 1 case suffering from permanent paresis. Conclusion Single- stage total CC was a safe, micro-invaded method to reduce the seizure frequency and severity of the patients with epileptic encephalopathy without added complications compared with partial CC.