涉及运动及语言区癫痫的外科治疗(附12例临床分析)

Surgical treatment for epilepsy involved in motor and language areas

目的探讨涉及运动及语言区癫痫的外科治疗方法,为提高功能区癫痫手术的治疗效果提供可靠依据。方法回顾性分析2011年1月至2014年5月经手术治疗的12例涉及运动及语言区癫痫患者的临床资料。患者均在颅内埋藏电极行长程视频脑电监测定位致痫区,术外患者清醒状态下经皮质电刺激确定脑功能区明确两者的位置关系,最后在保护脑功能的前提下切除致痫区。结果 12例患者中1例出现一过性运动性失语,1例出现暂时性对侧肢体轻偏瘫,1例出现一过性运动性失语及对侧上肢轻偏瘫,其余术后随访无明显神经功能障碍。术后随访6-48个月,EngelⅠ级6例,EngelⅡ级3例,EngelⅢ级2例,EngelⅣ级1例。结论颅内埋藏电极后定位致痫区及功能区可使功能区癫痫外科手术在最大程度保护脑功能的前提下尽可能地切除致痫区,提高手术疗效,减少并发症。

Objective To explore the strategy for the surgical treatment of epilepsy patients involved in motor and language areas, and provide the basis for improving the effect of surgical treatment of epilepsy patients in these areas. Methods Retrospective analysis of the clinical data in 12 patients who underwent surgical treatment involved in motor and language areas from 2011 to 2014. The epileptogenic areas of these patients were all located by the long-term video EEG after the electrode implanted into subdural, and the important function areas were defined by cortical electrical stimulation extraoperatively with patients awake. And then epileptogenic areas were resected during operation. Results 12 patients of epilepsy all treated by operation,the postoperative complications were short-time motor aphasia and then recovered in 1, temporary mild contralateral hemiplegia occurred in 1, short-time motor aphasia and contralateral upper limb hemiplegia in 1,all parents were followed up for 6 to 48months,Engel Ⅰ grade in 6 cases,Engel Ⅱ grade in 3 cases ,Engel Ⅲgrade in 2 cases,Engel Ⅳgrade in 1 cases. Conclusion The insertion of intracranial electrode to localize both epileptogenic zone and eloquent areas can allow a maximum resection of epileptogenic areas and reserve the important brain function maximally. Intracranial electrode and cortical electrical stimulation is an effective method to decrease postoperative complications and improve the curative effect.