大脑半球切除治疗难治性癫痫的术前评估及手术改良（附58例报告）

The preoperative evaluation and the surgical modification of the hemispherectomy in treatment intractable epilepsy（ report of 58 cases）

目的研究大脑半球切除治疗由一侧大脑半球广泛病变引起的难治性癫痫的术前评估及手术改良。方法回顾性分析清华大学玉泉医院癫痫中心2006年11月至2011年7月58例行大脑半球切除治疗癫痫病例。根据患者的临床发作、影像学及脑电图特点进行癫痫起源一侧半球的定侧；根据功能磁共振、磁共振弥散成像、PET—CT等进行术前神经功能分析及术后神经功能预测；选择制定合适的半球切除手术计划。结果58例均行一侧大脑半球切除，32例左侧半球，26例右侧半球，其中5例行保留运动区的大脑半球切除。无手术死亡，4例少量术腔出血，5例切口缺血愈合不良并脑脊液漏。随访1年至5年8个月，48例术后癫痫无发作；10例术后有程度不等的发作。按照Engle评分Ⅰ级48例（83％）；Ⅱ级7例（12％）；Ⅲ级3例（5％）。结论改良大脑半球切除对于一侧半球病变引起的难治性癫痫控制效果及脑功能代偿良好，无严重并发症，术后停药复发率低。

Objective To study modified hemispherectomy in treatment intractable epilepsy caused by lateral lesion of hemisphere. Methods 58 cases treated by hemispherectomywere retrospectively summariedin our ward fromNOV, 2006 -July, 2011. The epileptogenic hemispheres were determinted by analisising these patients＇ clinicalfeature, neuroimaging and scalp EEG. Their existent and prediction of post - surgicalneurofunction were evaluated by fMRI and/or PET - CT and/or DTI. In the end the surgical plan were made include the scalp insicion and whether remaining the eloquent areas. Results All of 58 patients received hemispherctomy,32 eases were left side,26 right side,5 cases remained the partial motor cortex according the fMRI. There was no severe complication and death occurred, only 4 patients had little hemorrhage in the postoperative cavity, 5 patients had poor wound healing for local ischemia and leakage of CSF. Patients were followed up from one year to 5 years and 8 months,48 patients （83%） were seizure free, 10 patients（ 17% ） had some seizures in various degree. In Engle criteria,48 patients（ 83% ） were Engle class 1,7 patients（12% ） were Engle class ]L3 patients（5% ） were Engle class ]][. Conclusion Hemisphereetomy is most effective treatment forintractable epilepsy caused by lateral lesion of hemisphere, for its excent in seizure control and no severe complication and better behavior and intelligence. Obviously, ourmodified hemisphrectomyhad advantage in seizure control to the intractableepilepsy caused by lateral lesion of hemisphere, advantage advantage.