岛周大脑半球离断术治疗药物难治性癫

Peri-insular hemispherectomy for intractable epilepsy

目的探讨岛周大脑半球离断术治疗一侧半球性病变所致难治性癫的疗效与安全性。方法回顾性分析21例难治性癫的病例资料,均采用岛周大脑半球离断术。结果病理报告:Rasmussen脑炎7例,软化灶14例。术后随访2~4年,Engel分级:Ⅰ级18例(85.7%),Ⅱ级2例(9.5%),Ⅲ级1例(4.8%)。病人术后均可独立行走,病人认知及生活能力较术前改善,但无统计学差异(P>0.05)。全部病人术后未出现严重神经功能损伤与死亡。结论岛周大脑半球离断术治疗半球性难治性癫手术疗效确定,是治疗半球病变性癫安全有效的方法。

Objective To assess the efficacy and safety ofperi-insular hemispherectomy for intractable epilepsy by unilateral hemisphere lesion. Methods The clinical data of 21 patients with intractable epilepsy, who received hemispherectomy through peri-insular approach, were analyzed retrospectively. Results The pathologicaldiagnosis was Rasmussen encephalitis in 7 patients and softening lesion in 14. All the patients were followed up for 2 to 4 years. Engel class Ⅰ was achieved in 18 patients （85.7%）, class Ⅱ in 2 （9.5%）, and class Ⅲ in 1 （4.8%）. All the patients walked independently after rehabilitation. The postoperative cognitive status and quality of life were better than those before surgery, but there was no statistic significance in the difference （P 〉 0.05）. All the patients had no severe neurological impairment and death after operation. Condusions Peri-insular hemispherectomy is a safe and effective procedure for intractable epilepsy caused by unilateral hemisphere lesion.