涉及中央前回的顽固性癫痫外科治疗

Surgical treatment for refractory epilepsy related to precentral gyrus

目的探索涉及中央前回的顽固性癫痫的外科治疗效果。方法癫痫发作起始位于或邻近中央前回的顽固性癫痫患者,开颅结合立体定向方法置入栅格状和深部电极。根据发作期颅内脑电图,电刺激,皮层诱发电位和高频颅内脑电图功能定位结果确定中央前回和致痫灶,镜下切除致痫灶。随访1年并回顾性分析23例患者致痫灶切除术后效果。结果癫痫治疗效果：EngelⅠ级19例;EngelⅡ级3例;EngelⅢ-Ⅳ级1例。所有患者致痫灶切除术后第1 d均出现单侧或单个肢体瘫痪,术后1年15例患者肌力恢复4级以上,无明显功能功能障碍,8例患者肌力3级及以下,遗留功能障碍。结论涉及中央前回的顽固性癫痫致痫灶切除术后多数患者可获得癫痫治愈而不遗留明显功能障碍。

Objective To explore the outcomes of epileptogenic zone resection of refractory epilepsy originating from areas related to precentral gyrus.Methods Patients with refractory epilepsy originating from areas related to precentral gyrus underwent intracranial electrodes implantation.Grid and depth electrodes were implanted through craniotomy associated by stereotactic technique.Precentral gyrus and epileptogenic zone resection were detected by intracranial EEG, electric stimulation, cortical evoked potentials and high frequency oscillation. Epileptogenic zone was resected under microscope .Results The outcome of epilepsy showed 19 in Engel Ⅰ,3 in Engel Ⅱand 1 in Engel Ⅲ-Ⅳ.All patients experienced unilateral or single limb hemiplegia on first postoperative day.15 cases, with muscle strength over grade 4, had no obvious dysfunction at 1 year after operation and 8 cases with muscle strength grade 3 or lower, had dysfucntion.Conclusion Most patients of refractory epilepsy originating from areas related to precentral gyrus were seizure free and had no obvious dysfunction after epileptogenic zone resection.