不同术式治疗中央区癫痫的疗效对比

A comparative study of different surgical treatment of epilepsy in rolandic and immediate perirolandic cortex

目的探索中央区癫痫的外科治疗方法。方法回顾性分析2010年1月至2016年1月接受手术治疗的癫痫患者376例,其中48例患者符合标准纳入研究。将患者分为中央区皮层内切除组(A组,n=28)和中央前区邻近皮质及切除及中央区多处软脑膜膜下横纤维切断术组(B组,n=20),分析术后癫痫控制情况及神经功能障碍状况。结果术后EngelⅠ级22例(45.8%),EngelⅡ级7例(14.6%),Engel Ⅲ级10例(20.8%),Engel Ⅳ级9例(18.8%)。其中A组癫痫控制满意率(EngelⅠ级+EngelⅡ级)67.9%,较B组50.0%高(P=0.036);两组间在临时和永久性神经功能障碍方面差异无统计学上意义(分别为P=0.569,P=0.418)。结论在部分中央区癫痫患者完全切除致癫灶而不损害大脑皮层并获得满意疗效是可能实现的。良好的手术预后与致癫灶切除程度相关,与神经功能障碍无确切相关性。

Objective To explore the surgical treatment of epilepsy in rolandic and immediate perirolandic cortex. Methods 376 patients accepted surgical treatment in our hospital from January 2010 to January 2016, of whom 48 patients fulfilled eligibility criteria and were included in the study. Patients were divided into 2 groups for analysis ： patients with resections in the rolandic cortex （A group, n = 28）, and patients with resections in immediate perirolandic cortex and simultaneous sensorimotor multiple subpial transections （B group, n = 20）. Postoperative seizure outcome and neurologic deficits were analyzed. Results According to classification of Engel, Engel Ⅰ was in 22 （45.8%）, Engel Ⅱ in 7 （ 14.6%）, EngelⅢ in 10 （20.8%） and Engel Ⅳ in 9（18.8%）. Seizure outcome satisfaction rate （Engel Ⅰ ＋Engel Ⅱ ） in the group A was significantly higher than the group B （P = 0.036） ; temporary and transient neurological deficits in the two groups had no statistically significant （P = 0.569, P = 0.418）. Conclusions It is possible to achieve complete dissection of epileptic foci in rolandic and immediate perirolandic cortex without damage. The good prognosis is not related to the degree of excision of epilepsy and has no definite correlation with neurological dysfunction.