改良大脑半球离断术治疗儿童半球病变导致的难治性癫痫

Modified hemispherotomy for the treatment of refractory epilepsy secondary to cerebral hemispheric disorders in children

目的 探讨采用改良大脑半球离断术治疗儿童半球病变导致的难治性癫痫的手术经验及疗效.方法 回顾性分析2015年9月至2016年6月复旦大学附属儿科医院神经外科采用改良大脑半球离断术治疗的无明显大脑半球萎缩、脑室系统无明显扩张的难治性癫痫患者的临床资料,共5例.年龄为8个月至8岁;左侧半球离断3例,右侧2例.结果 手术时间为5～6h,术中出血量为100 ～ 300 ml,平均（170 ＆#177;84）ml.术后MRI显示大脑半球离断完全,无一例发生出血、脑梗死、感染及脑积水.术后随访4 ～13个月,所有患儿均无癫痫发作;4例已减少抗癫痫药物用量,1例停药;5例均可独立行走,无语言功能障碍,均遗留对侧上肢轻偏瘫,神经心理发育同治疗前.结论 改良大脑半球离断术治疗儿童半球病变所致的难治性癫痫安全、有效,可以减少术中出血,降低手术难度,尤其适用于大脑半球萎缩不明显、脑室系统无扩张的患者.

Objective To discuss our experience and efficacy of modified hemispherotomy for the treatment refractory epilepsy secondary to cerebral hemispheric disorders in children.Methods From September 2015 to June 2016,a series of 5 patients with intractable epilepsy underwent modified hemispherotomy at Neurosurgery Department of Children＆#39;s Hospital of Fudan University and were enrolled into this retrospective study.None of the patients had cerebral hemispheric atrophy or enlarged ventricles.Their ages at surgery ranged from 8 months to 8 years.The left hemisphere was involved in 3 cases and the right in 2.Results The operation time was 5-6 h and the amount of blood loss was 100-300 ml （mean：170 ＆#177; 84 ml）.Postoperative MRI revealed complete disconnection of the affected hemisphere in all patients.There was no hemorrhage,cerebral infarction,infection or hydrocephalus.Postoperative follow-up lasted 4-13 months and all patients were seizure free.Four patients had reduced the dose of antiepileptic drug （AED） and 1 case stopped AED.All of the 5 patients were able to walk independently without any language impairment.All patients reported slight hemiplegia in the contralateral side.Neuropsychological development remained unchanged compared with preoperative status.Conclusions Modified hemispherotomy is suggested to be effective and safe for the treatment of intractable epilepsy related to cerebral hemispheric disorders,particularly in those patients without cerebral hemispheric atrophy or enlarged ventricles.The procedure could help reduce the blood loss during operation and is associated with less surgical difficulty.