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开创我国癫外科治疗的新局面 被引量:2
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作者 栾国明 《中国微侵袭神经外科杂志》 CAS 2008年第11期481-482,共2页
癫是由多种原因引起的常见病和多发病,在我国,癫患病率达7‰,其中活动性癫占5‰,也就是说,我国有近千万的癫病人,其中30%是药物难治性癫,该类病人如经综合术前评估,至少有1/2可选择适当的外科治疗并从中获益。近年来。
关键词 癫外科 电刺激疗法 规范
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脑磁图癫灶和皮层功能区定位在癫外科的应用 被引量:14
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作者 朱丹 谭启富 +1 位作者 郭强 华刚 《临床神经外科杂志》 CAS 2008年第2期77-80,共4页
目的探讨脑磁图在癫外科术前评估中的应用价值。方法回顾性分析216例手术治疗顽固性癫病例,术前应用脑磁图辅助定位皮层癫灶及重要皮质功能区范围,其中18例将脑磁图与神经导航系统结合。结果本组216例患者,按照Engel癫疗效分级... 目的探讨脑磁图在癫外科术前评估中的应用价值。方法回顾性分析216例手术治疗顽固性癫病例,术前应用脑磁图辅助定位皮层癫灶及重要皮质功能区范围,其中18例将脑磁图与神经导航系统结合。结果本组216例患者,按照Engel癫疗效分级,Ⅰ级71.75%,Ⅱ级10.19%,Ⅲ级8.80%,Ⅳ级9.26%。脑磁图癫灶定位与术中皮质脑电图定位符合率87.9%。无一例出现手术后永久神经功能障碍。结论脑磁图是无创确定癫灶和功能区皮质空间位置关系的重要工具,脑磁图结合神经导航术前和术中的皮质功能区定位方法应用可使癫外科实现微侵袭和精确手术。 展开更多
关键词 脑磁图 癫外科 皮质功能区 神经导航
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MRI阴性难治性儿童额叶癫的脑电图特点及外科治疗(附25例分析) 被引量:1
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作者 林久銮 周文静 +7 位作者 刘晓燕 张光明 王东明 罗阳 石岩芳 刘晓华 宋宪成 胡翠丽 《中国微侵袭神经外科杂志》 CAS 2008年第11期492-495,共4页
目的总结分析MRI阴性难治性儿童额叶癫的脑电图特点及手术治疗方法和预后。方法回顾性分析25例MRI阴性难治性儿童额叶癫病例的治疗经验。根据病儿发作的症状及头皮脑电图特点,在可疑的癫灶起源区植入颅内电极,行皮质脑电图(ECoG)... 目的总结分析MRI阴性难治性儿童额叶癫的脑电图特点及手术治疗方法和预后。方法回顾性分析25例MRI阴性难治性儿童额叶癫病例的治疗经验。根据病儿发作的症状及头皮脑电图特点,在可疑的癫灶起源区植入颅内电极,行皮质脑电图(ECoG)监测,根据其间期、发作期特点制定癫灶切除计划。病灶位于功能区时术中行皮质电刺激,进行癫灶及功能区定位。结果本组行单纯前额叶切除7例,前额叶切除加局限性皮质切除4例,局限性皮质切除加皮质热灼6例,前额叶外侧切除加局限性皮质切除3例,前额叶内侧切除加局限性皮质切除5例(其中3例加胼胝体切开);对其中6例灶位于功能区病人于局限性皮质切除后加行皮质热灼。无手术死亡及严重并发症发生,随访12~24个月,手术后疗效按Wilson标准评判,癫发作完全消失7例,发作次数显著减少8例,发作程度减轻6例,无明显改善4例;优良率为84%。结论分析头皮脑电图初步定位癫灶后,再应用颅内电极进行精确致灶及功能区定位,制定个体化治疗计划,选择前额叶切除、局限性皮质切除、皮质热灼、胼胝体切开或根据需要联合多种术式,是治疗MRI阴性难治性儿童额叶癫的有效方法。 展开更多
关键词 癫 额叶 癫外科 儿童 脑电描记术
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无病灶性癫术前长程颅内电极埋置的适应证探讨
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作者 蔡立新 李勇杰 张国君 《中国微侵袭神经外科杂志》 CAS 2008年第11期499-502,共4页
目的探讨无病灶性顽固性癫手术前应用长程颅内电极埋置术定位致灶的适应证及可能将其省略的条件。方法回顾性分析82例术前MRI与CT证实无明显结构性病灶癫病人的手术治疗经验。根据我研究所制定的术前埋置电极适应证标准,采用电极... 目的探讨无病灶性顽固性癫手术前应用长程颅内电极埋置术定位致灶的适应证及可能将其省略的条件。方法回顾性分析82例术前MRI与CT证实无明显结构性病灶癫病人的手术治疗经验。根据我研究所制定的术前埋置电极适应证标准,采用电极埋置39例(埋置组),省略电极埋置43例(非埋置组)。术后随访1年以上,总结两组术前各项评估结果的特点,并比较手术预后效果。结果埋置组术后EngelⅠ与Ⅱ级25例(64.1%),非埋置组术后EngelⅠ与Ⅱ级20例(46.5%);两组比较,差异无统计学意义(P>0.05)。结论对于无病灶性顽固性癫病人,长程颅内电极监测是保障手术效果的一项重要手段。然而当发作间期异常放电焦点局限在单一脑叶并与发作起始点部位相一致时,如果此部位与发作症状学定位不悖,且在满足其他一定条件的前提下,少数病人可考虑省略颅内电极埋置而直接行致灶切除手术。 展开更多
关键词 癫外科 颅内电极 无病灶性癫 适应证 脑电描记术
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儿童顽固性癫术前致灶的评估与手术疗效
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作者 蔡立新 李建宇 +1 位作者 杜薇 李勇杰 《临床神经电生理学杂志》 2008年第4期243-246,共4页
关键词 癫 癫外科 致灶(EZ) 发作间期样放电(IED) 发作期异常放电(ID) 发作起始灶(IOZ) 局灶性皮质发育不良(FCD)
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DIAGNOSTIC VALUE OF INTERICTAL DIFFUSION-WEIGHTED IMAGING IN EVALUATION OF INTRACTABLE TEMPORAL LOBE EPILEPSY 被引量:6
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作者 Rui Wang Sa-ying Li Min Chen Cheng Zhou 《Chinese Medical Sciences Journal》 CAS CSCD 2008年第2期68-72,共5页
Objective To explore the ability of interictal diffusion-weighted imaging(DWI)to localize the temporal lobe of seizure origin and to predict postoperative seizure control in patients with temporal lobe epilepsy(TLE).M... Objective To explore the ability of interictal diffusion-weighted imaging(DWI)to localize the temporal lobe of seizure origin and to predict postoperative seizure control in patients with temporal lobe epilepsy(TLE).Methods Twenty-seven patients with intractable TLE considered for surgery and 19 healthy volunteers were studied with conventional magnetic resonance imaging(MRI)and DWI.Apparent diffusion coefficients(ADCs)of bilateral hippocampi in both TLE patients and control subjects were obtained.Lateralization to either temporal lobe with hippocampal ADC was based on the threshold values derived from ±1SD of right/left ratios in normal subjects.And the postoperative pathology was reviewed.Results Hippocampal ADCs were higher on the side of surgery compared with those on the contralateral side as well as the ipsilateral side in control subjects [resected side(109.8±7.3)×10-5 cm2/s,contralateral side(91.7±4.7)×10-5 cm2/s,control subjects(81.6±5.2)×10-5 cm2/s,all P<0.01].Right/left hippocampal ADC ratio and conventional MRI lateralized to the operated temporal lobe in 21 of 27(77.8%)and in 18 of 27(66.7%)patients.Lateralization to the surgical side was not associated with postoperative seizure control with right/left hippocampal ADC ratio(P>0.05).Conclusions Conventional MRI is a sensitive method to detect hippocampal sclerosis.Accuracy of the right/left hippocampal ADC ratio for lateralizing to the side of surgery is very high,but it isn't a better predictor of surgical outcome. 展开更多
关键词 magnetic resonance imaging temporal lobe epilepsy epilepsy surgery
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Electrocorticography with Direct Cortical Stimulation for a Left Temporal Glioma with Intractable Epilepsy
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作者 Resha Shrestha Kuo Li +2 位作者 Wei Wang Hal-ping Lian Mao-de Wang 《Chinese Medical Sciences Journal》 CAS CSCD 2012年第1期54-56,共3页
ELECTROCORTICOGRAPHY (ECoG), the intraoperative recording of cortical potentials, has played an important role in the surgical management of patients with medically intractable epilepsy. This technique is useful in ep... ELECTROCORTICOGRAPHY (ECoG), the intraoperative recording of cortical potentials, has played an important role in the surgical management of patients with medically intractable epilepsy. This technique is useful in epilepsy surgery to delineate margins of epileptogenic zones, guide resection, 展开更多
关键词 ELECTROCORTICOGRAPHY intractable epilepsy direct cortical stimulation speech area
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Electrocorticography-Guided Surgical Treatment of Solitary Supratentorial Cavernous Malformations with Secondary Epilepsy 被引量:2
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作者 Chao Wang Chao You +3 位作者 Guo-qiang Han Jun Wang Yun-biao Xiong Chuang-xi Liu 《Chinese Medical Sciences Journal》 CAS CSCD 2014年第2期112-116,共5页
Objective To evaluate the efficacy of electrocorticographic(ECoG) monitoring and the application of different surgical approaches in the surgical treatment of solitary supretentorial cavernous malformations with secon... Objective To evaluate the efficacy of electrocorticographic(ECoG) monitoring and the application of different surgical approaches in the surgical treatment of solitary supretentorial cavernous malformations with secondary epilepsy. Methods This study enrolled a consecutive series of 36 patients with solitary supratentorial cavernous malformations and secondary epilepsy who underwent surgery with intraoperative ECoG monitoring in the Department of Neurosurgery between January 2004 and January 2008. The patients were composed of 15 males and 21 females, aged between 8 and 52 years(mean age 27.3±2.8 years) at the time of surgery. Epilepsy history, the type of epilepsy at the presentation, lesion location, the incidence of residual epileptiform discharges, and postoperative outcomes were evaluated. Results Histopathological examination indicated cavernous malformations and hippocampal sclerosis in 36 and 5 cases, respectively. Neuronal degeneration, glial cell proliferation, and neurofibrillary tangles were found in all the resected cerebral tissues of extended lesionectomy of residual epileptic foci. Lesionectomy, anterior temporal lobectomy, anterior temporal lobectomy plus cortical thermocoagulation, extended lesionectomy, extended lesionectomy plus cortical thermocoagulation were performed in 4, 4, 1, 14, and 13 cases, respectively. Residual epileptiform discharges were captured in 9 out of the 14 patients who had additional cortical thermocoagulation. According to Engle class for postoperative outcomes, 27 cases were class I(75.00%), 5 were class II(13.89%), 2 were class III(5.56%), and 2 were class IV(5.56%), thus the total effective rate(class I+class II) was 88.89%. Neither of epilepsy history, the type of epilepsy, and the location of cavernous malformation was significantly related to outcomes(P>0.05). A significant relationship was found between the incidence of residual epileptiform discharges and outcomes(P=0.041). Conclusions Intraoperative ECoG monitoring, the application of different surgical approaches, and the resection of residual epileptic foci could produce good result in the surgical treatment of supratentorial cavernous malformation with secondary epilepsy. Postoperative residual epileptiform discharges could be a useful predictor for evaluating the outcomes. 展开更多
关键词 ELECTROCORTICOGRAPHY cavernous malformation EPILEPSY
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