BACKGROUND Neurosurgical treatment of severe bilateral occipital lobe epilepsy usually involves two operations several mos apart.AIM To evaluate surgical resection of bilateral occipital lobe lesions during a single o...BACKGROUND Neurosurgical treatment of severe bilateral occipital lobe epilepsy usually involves two operations several mos apart.AIM To evaluate surgical resection of bilateral occipital lobe lesions during a single operation as a treatment for bilateral occipital lobe epilepsy.METHODS This retrospective case series included patients with drug-refractory bilateral occipital lobe epilepsy treated surgically between March 2006 and November 2015.RESULTS Preoperative evaluation included scalp video-electroencephalography(EEG),magnetic resonance imaging,and PET-CT.During surgery(bilateral occipital craniotomy),epileptic foci and important functional areas were identified by EEG(intracranial cortical electrodes)and cortical functional mapping,respectively.Patients were followed up for at least 5 years to evaluate treatment outcome(Engel grade)and visual function.The 20 patients(12 males)were aged 4-30 years(median age,12 years).Time since onset was 3-20 years(median,8 years),and episode frequency was 4-270/mo(median,15/mo).Common manifestations were elementary visual hallucinations(65.0%),flashing lights(30.0%),blurred vision(20.0%)and visual field defects(20.0%).Most patients were free of disabling seizures(Engel grade I)postoperatively(18/20,90.0%)and at 1 year(18/20,90.0%),3 years(17/20,85.0%)and≥5 years(17/20,85.0%).No patients were classified Engel grade IV(no worthwhile improvement).After surgery,there was no change in visual function in 13/20(65.0%),development of a new visual field defect in 3/20(15.0%),and worsening of a preexisting defect in 4/20(20.0%).CONCLUSION Resection of bilateral occipital lobe lesions during a single operation may be applicable in bilateral occipital lobe epilepsy.展开更多
目的探讨颅脑结构性病变所致癫痫的伽玛刀(γ-刀)治疗方法,评价治疗效果及视频脑电图(VEEG)随访的意义。方法回顾性分析山东省戴庄医院伽玛刀治疗科和神经科2017-01—2021-06确诊的60例颅脑结构性病变所致癫痫患者的临床资料,根据是否...目的探讨颅脑结构性病变所致癫痫的伽玛刀(γ-刀)治疗方法,评价治疗效果及视频脑电图(VEEG)随访的意义。方法回顾性分析山东省戴庄医院伽玛刀治疗科和神经科2017-01—2021-06确诊的60例颅脑结构性病变所致癫痫患者的临床资料,根据是否采用γ-刀治疗将其分为单纯药物治疗组(对照组)和γ-刀联合药物治疗组(γ-刀组),每组30例,进行随访观察,分析γ-刀治疗的效果及随访VEEG检测结果。结果在1~2 a的随访期内,γ-刀组患者癫痫总改善率76.67%,对照组为36.67%,差异有统计学意义(P<0.05);γ-刀组EEG痫样放电检出率30.00%,对照组为66.67%;γ-刀组癫痫控制显效组EEG正常率为50%,明显高于有效组的11.11%及无效组的0,显效组EEG痫样波检出率(7.14%)明显低于有效组(22.22%)和无效组(85.71%)。γ-刀治疗后随访期内癫痫发作改善率分别为0.5~1 a 63.33%,>1~2 a 76.67%,>2~3 a 80.77%,3 a以上82.61%;VEEG痫样波检出率分别为0.5~1 a63.33%,>1~2 a 30.00%,>2~3 a 23.08%,3 a以上21.74%。术后并发放射性脑水肿3例(10.00%)。结论γ-刀治疗颅内结构性病变所致的难治性癫痫效果明确,VEEG有助于γ-刀治疗方案的设计、评估治疗效果和指导治疗后用药。展开更多
目的研究病灶性新皮质癫癎发作间期MEG和MRI一致性与预后的关系。方法 23例病灶性新皮质癫癎接受了术前评估及手术治疗,所有患者术前均接受MEG检测,数据分析处理采用等价电流偶极子(ECD)法和合成孔径法(SAMg2)。7例患者接受了颅内电极...目的研究病灶性新皮质癫癎发作间期MEG和MRI一致性与预后的关系。方法 23例病灶性新皮质癫癎接受了术前评估及手术治疗,所有患者术前均接受MEG检测,数据分析处理采用等价电流偶极子(ECD)法和合成孔径法(SAMg2)。7例患者接受了颅内电极植入后长程视频皮层脑电图监测。术后随访一年以上并运用Engel法评价预后。结果 MEG与MRI一致的病例手术有效率(Engel class I or Ⅱ)及术后无发作率(Engel class IA)均优于不一致者。结论病灶性新皮质癫癎,MEG结果与MRI结果一致时手术效果良好,对此类病例不需要再进行颅内电极植入行癫癎灶定位,颅内电极植入仅适用于MEG结果与MRI结果不一致的病例或需要功能区定位者。展开更多
文摘BACKGROUND Neurosurgical treatment of severe bilateral occipital lobe epilepsy usually involves two operations several mos apart.AIM To evaluate surgical resection of bilateral occipital lobe lesions during a single operation as a treatment for bilateral occipital lobe epilepsy.METHODS This retrospective case series included patients with drug-refractory bilateral occipital lobe epilepsy treated surgically between March 2006 and November 2015.RESULTS Preoperative evaluation included scalp video-electroencephalography(EEG),magnetic resonance imaging,and PET-CT.During surgery(bilateral occipital craniotomy),epileptic foci and important functional areas were identified by EEG(intracranial cortical electrodes)and cortical functional mapping,respectively.Patients were followed up for at least 5 years to evaluate treatment outcome(Engel grade)and visual function.The 20 patients(12 males)were aged 4-30 years(median age,12 years).Time since onset was 3-20 years(median,8 years),and episode frequency was 4-270/mo(median,15/mo).Common manifestations were elementary visual hallucinations(65.0%),flashing lights(30.0%),blurred vision(20.0%)and visual field defects(20.0%).Most patients were free of disabling seizures(Engel grade I)postoperatively(18/20,90.0%)and at 1 year(18/20,90.0%),3 years(17/20,85.0%)and≥5 years(17/20,85.0%).No patients were classified Engel grade IV(no worthwhile improvement).After surgery,there was no change in visual function in 13/20(65.0%),development of a new visual field defect in 3/20(15.0%),and worsening of a preexisting defect in 4/20(20.0%).CONCLUSION Resection of bilateral occipital lobe lesions during a single operation may be applicable in bilateral occipital lobe epilepsy.
文摘目的探讨颅脑结构性病变所致癫痫的伽玛刀(γ-刀)治疗方法,评价治疗效果及视频脑电图(VEEG)随访的意义。方法回顾性分析山东省戴庄医院伽玛刀治疗科和神经科2017-01—2021-06确诊的60例颅脑结构性病变所致癫痫患者的临床资料,根据是否采用γ-刀治疗将其分为单纯药物治疗组(对照组)和γ-刀联合药物治疗组(γ-刀组),每组30例,进行随访观察,分析γ-刀治疗的效果及随访VEEG检测结果。结果在1~2 a的随访期内,γ-刀组患者癫痫总改善率76.67%,对照组为36.67%,差异有统计学意义(P<0.05);γ-刀组EEG痫样放电检出率30.00%,对照组为66.67%;γ-刀组癫痫控制显效组EEG正常率为50%,明显高于有效组的11.11%及无效组的0,显效组EEG痫样波检出率(7.14%)明显低于有效组(22.22%)和无效组(85.71%)。γ-刀治疗后随访期内癫痫发作改善率分别为0.5~1 a 63.33%,>1~2 a 76.67%,>2~3 a 80.77%,3 a以上82.61%;VEEG痫样波检出率分别为0.5~1 a63.33%,>1~2 a 30.00%,>2~3 a 23.08%,3 a以上21.74%。术后并发放射性脑水肿3例(10.00%)。结论γ-刀治疗颅内结构性病变所致的难治性癫痫效果明确,VEEG有助于γ-刀治疗方案的设计、评估治疗效果和指导治疗后用药。
文摘目的研究病灶性新皮质癫癎发作间期MEG和MRI一致性与预后的关系。方法 23例病灶性新皮质癫癎接受了术前评估及手术治疗,所有患者术前均接受MEG检测,数据分析处理采用等价电流偶极子(ECD)法和合成孔径法(SAMg2)。7例患者接受了颅内电极植入后长程视频皮层脑电图监测。术后随访一年以上并运用Engel法评价预后。结果 MEG与MRI一致的病例手术有效率(Engel class I or Ⅱ)及术后无发作率(Engel class IA)均优于不一致者。结论病灶性新皮质癫癎,MEG结果与MRI结果一致时手术效果良好,对此类病例不需要再进行颅内电极植入行癫癎灶定位,颅内电极植入仅适用于MEG结果与MRI结果不一致的病例或需要功能区定位者。
