多处软膜下横切联合其它术式治疗顽固性癫痫

Treatment of intractable epilepsy with multiple subpial transection in combination with other operations

目的 探讨多处软膜下横纤维切断术 (MST)联合病灶或 /和致痫脑叶切除术对顽固性癫痫的治疗效果。方法 术前将临床、脑电图、神经影像学及SPECT检查结果进行综合分析、定位。取大骨瓣开颅 ,术中行皮层脑电 (ECoG)监测。首先切除脑的结构性病灶 ,对颞叶癫痫 ,行较小范围的前颞叶切除 (含颞叶内侧结构 ) ;对痫灶位于额极底面者 ,行额极切除。复查ECoG ,对残余的痫样放电区域 ,不论是否位于重要功能区 ,均行MST直至术野内痫样波基本消失。术后继续服用抗痫药治疗 2年方可考虑逐渐减量或停药。结果 本组 6 7例无手术死亡和明显并发症。随访 1～ 7年 ,有效率 (发作频率减少 5 0 %以上 )为 91.0 % ,显效率 (发作频率减少 75 %以上 )为 80 .6 % ,效差或无效 9.0 %。术后复查脑电图多有明显改善。结论 在顽固性癫痫的治疗中 ,MST联合病灶或 /和致痫脑叶切除 ,既能取得较好的疗效又能保留更多的脑功能。

Objective To evaluate the effects of multiple subpial transection (MST) in combination with resection of lesion or/and epileptogenic lobectomy on intractable epilepsy.Methods Epileptogenic focus was determined by the aid of clinical data, diagnostic imaging, single photon emission computed tomography (SPECT) and electroencephalography. Electrocorticography was done during operation in detail, and structure lesion was resected firstly, then anterior temporal lobectomy defined in smaller area than common (including amygdalo hippocampectomy) was used in temporal lobe epilepsy . Frontopolar was resected if epileptogenic focus positioned on subfrontal surface. The area with residual epileptic seizure revealed by electrocorticography was dealt with MST whether it located in functional or non functional cortex untill epileptic waves disappeared. All patients received anti epileptic drugs for two years during which the drug doses were gradually reduced. Results No death and severe complication after the surgery occurred in 67 patients. All the patients were followed up for one to seven years, yielding excellent or good results in 80.6% (seizure frequency reduced >75%), gross efficiency rate in 91.0% (seizure frequency reduced >50%), no remarkable changes in 9.0%. Follow uped electroencephalography showed significant improvement. Conclusion MST combined with resection of lesion or/and epileptogenic lobectomy on intractable epilepsy can gain good results and keep normal function of brain tissue.