胼胝体全段切开术治疗药物难治性癫[疒间]

Total corpus callosum incision for drug-refractory epilepsy

目的研究胼胝体全段切开术治疗药物难治性癫■的安全性和有效性,并探讨其在二期切除性手术的作用。方法回顾性分析40例药物难治性癫■病例资料,发作类型:强直发作31例,跌倒发作14例,痉挛发作5例,强直-阵挛发作3例和肌阵挛发作3例。经术前评估后行胼胝体全段切开术,术后定期随访癫■控制情况,癫■控制疗效不佳者再行二期手术评估。结果术后随访1~3年,癫■控制达到EngelⅠ级10例,Ⅱ级11例,Ⅲ级12例,Ⅳ级7例,手术总有效率达82.5%;结果显示:跌倒发作和强直发作减少明显。术后并发症:急性失连接综合征4例,硬膜下积液3例,硬膜下积血1例,经相应处理后恢复正常。术后韦氏智力与记忆力较术前改善(均P <0.05)。术后间歇期脑电图(electroencephalogram,EEG)转化为一侧癫■样放电为主29例(72.5%),癫■发作能定侧13例(32.5%)。6例病人经再次评估后行二期致■灶切除术,二期手术后癫■无发作。结论胼胝体全段切开术是一种治疗药物难治性癫■安全有效的方法,同时还可改善病人神经认知功能,且有助于二期致■灶切除术的术前评估定位,但需要严格把握适应证。

Objective To study the safety and effectiveness of total corpus callosum incision in the treatment of drug-refractory epilepsy,and explore its role in secondary resection. Methods The clinical data of 40 patients with drug-refractory epilepsy were analyzed retrospectively. The types of epilepsy was tonic seizures in 31 cases, fall seizures in 14, spastic seizures in 5, tonic-clonic seizures in 3 and myoclonic seizures in 3. After preoperative evaluation, a total corpus callosum incision was performed, and epilepsy control was followed up regularly after surgery. Those with poor efficacy in epilepsy control were evaluated by second-stage surgery. Results After1 to 3 years of follow-up, epilepsy control reached Engel grade Ⅰin 10 cases, gradeⅡ in 11, grade Ⅲ in 12 and grade Ⅳ 7. The total effective rate of the operation was 82.5%, and the fall seizures and tonic seizures were significantly reduced. Postoperative complications were acute disconnection syndrome in 4 cases, subdural effusion in 3 and subdural hemorrhage in 1. They returned to normal after corresponding treatment. The postoperative Webster’s intelligence and memory were improved compared with preoperation(both P <0.05).The intermittent EEG after surgery was converted to one-sided epileptiform discharge in 29 cases(72.5%), and epileptic seizures were able to be localized in 13(32.5%). The 6 patients were performed of second-stage epileptic focus resection after reassessment, and no seizures occurred after the second-stage operation. Conclusions The total corpus callosum incision is a safe and effective method for drug-refractory epilepsy. It can also improve the patient’s neurocognitive function and help the preoperative evaluation and positioning of the secondary epileptic foci resection. But it is necessary to strictly master the surgical indications.