儿童脑炎后难治性癫痫的手术治疗

Surgical treatment in children with postencephalitic epilepsy

脑炎后癫痫是儿童难治性癫痫的常见原因之一。根据脑炎急性期的病因可分为感染相关性和免疫相关性。病因的不同直接导致了能否手术以及手术方式的不同。Rasmussen脑炎是大脑半球离断术的手术指征。病毒性脑炎后癫痫并非外科手术的绝对禁忌,经过规范的术前评估,可行切除性或离断性等根治性手术治疗。自身免疫性脑炎后癫痫为外科切除性手术禁忌,若发作频繁,可选择迷走神经电刺激术等神经调控治疗。

Postencephalitic epilepsy(PE)is one of the common causes of refractory epilepsy in children.According to the cause of acute phase encephalitis,the etiology can be divided into infectious and immune,which lead to different treatment and surgical strategies.Rasmussen encephalitis is a surgical indication for hemispherotomy.Viral PE is not an absolute contraindication to surgery.After a standard preoperative evaluation,children may undergo resective or disconnective surgery.Autoimmune PE is a contraindication for surgical resection.If seizures are frequent,neuromodulation such as vagus nerve stimulation may be selected.