中央区癫痫的唤醒手术及疗效观察

Awake surgery for Rolandic's epilepsy and it's clinical effects

目的 探讨唤醒下手术治疗中央区癫痫的临床效果.方法 回顾性分析我科手术治疗的548例癫痫患者的临床资料,12例符合本研究标准.综合评估后在相应部位埋置颅内电极,经颅内电极脑电图（Intraeranial-EEG i-EEG）确定癫痫起始区（epileptic onset zone,EOZ）、皮层电刺激（cortical electro-stimulation,CES）描记脑功能区后,在麻醉唤醒状态下切除EOZ区及周围异常组织,以更好的保留脑功能.对切除组织进行病理学研究.结果 EOZ位于中央前-后回者3例（左侧1例、右侧2例）、中央前回者6例（左侧2例、右侧4例）、中央后回者3例（左侧1例、右侧2例）.病理学证实：皮质发育不良7例（ⅡA型3例、ⅡB型2例、灰质异位2例）、脑囊虫2例、脑软化灶（胶质增生）2例、海绵状血管瘤1例.随访2～5年,均系统服用抗癫痫药物（2例遵医嘱停服）,癫痫发作完全消失（Engel-Ⅰ级）7例、有发作先兆且偶有发作（Engel-Ⅱ级）3例、发作次数减少（Engel-Ⅲ级）2例.手术后早期出现运动-浅感觉功能障碍者2例、单纯运动功能下降者5例、出现深-浅感觉功能减退者1例.经半年的功能康复训练,6例患者运动功能恢复、感觉功能部分恢复,2例患者仍轻偏瘫,但肢体远端精细功能部分恢复.结论 EOZ位于中央区也可行切除性手术,术中唤醒能更好的保护脑功能.

Objective To explore the clinical effects of awake surgery for Rolandic＇ s epilepsy. Methods The clinical data of 548 patients with epilepsy operated in our department were analyzed retrospectively. 12 cases of them were Rolandic＇ s epilepsy who had underwent awake surgery for epileptogenic zone（EOZ） resection after preoperative comprehensive evaluation, including their MRI scan, i-EEG monitoring and cortical electro-stimulation （CES）. Pathological study was performed to analyze the tissue natures. Results There were 3 cases whose EOZ were located in both pre- and post-central gyri areas, and 6 in pre-central gyri and 3 in post-central gyri. The results of the pathologies included malformation of cortical dysplasie （7 cases ）, cerebral eysticercosis （2 cases ）, encephalomalacia（2 cases） and cavernous hernangioma（ 1 case）. After 2 to 5 years follow-up ,7 cases were seizure free（Engel-I）,3 had aura attack and occasionally seizures（Engel-H） and 2 had lesser attack（Engel-m） than pre-operation. All cases were constant drug treatment except 2 cases drug withdrawal after listening to doctor＇ s advice. Surgical complications were found in post-operative early time with 2 cases having dysfunction in movement and superficial sensibility, 5 cases in movement and 1 case in proprioceptive and superficial sensibility. Rehabilitation nursing had been used to help them for half a year, 5 cases were recovered to normal movement and 3 had mild paralysis with bad fine motor functions in limb extremities. Conclusion Awake surgery can protect the cerebral function more carefully during EOZ resection in central areas.