多软脑膜下横切术治疗功能区顽固性癫痫

The treatment of intractable epilepsy on functional cortex with multiple subpial transection

目的探讨采用多软脑膜下横切术治疗功能区顽固性癫痫发作和保护皮质功能的可行性。方法选择20例顽固性癫痫病人(其痫性放电均累及主要功能区)。切开硬脑膜后,先用皮质电极确定致痫灶,再横切传导痫性放电的神经元树突纤维,一直到棘尖波完全消除为止。结果术后随访6～35个月,癫痫控制满意6例,显著改善6例,良好5例,减轻2例,无改善1例,总有效率为95%,无手术死亡。结论多软脑膜下横切术在不引起显著神经功能缺失的情况下,能较有效地控制癫痫发作,因而是治疗功能区顽固性癫痫的首选方法。

Objective To explore the feasibility of multiple subpial transection for treatment of the functional area intractable seizure while preserving cortex function.Methods Twenty patients with intractable epilepsy,in which epileptic discharge involved the major functional area,were selected for operation.After incising dura mater,we located epileptic focus with cortical electrodes and transected the nueron's dendritic fiber until spike and sharp waves completely disappeared.Results The follow up time was 6 to 35 months postoperatively seizure was completely controled in 6 patients,significantly improved in 6,well controled in 5,reduced in 2,and not improved in 1.The total efffective rate was 95%.There was no operative mortality.Conclusions Multiple subpial transection leads to effective seizure control without significant neurological deficit,so it can be the first choice for treatment of intractable epilepsy on functional cortex.