外伤后晚期难治性癫痫的手术治疗

目的探讨外伤后晚期难治性癫痫的致痫灶精确定位、手术方法及其治疗效果。方法68例外伤后晚期难治性癫痫患者，采用神经影像学、视频脑电图、症状学以及术中皮层脑电图（ECoG）监测等方法综合定位致痫灶。采取单纯脑软化灶切除术治疗11例，脑软化灶＋周边致痫皮层切除术治疗31例，脑软化灶＋周边致痫皮层切除十功能区致痫皮层低功率电凝热灼术或多处软膜下横切术治疗20例，脑软化灶＋周边致痫皮层切除术＋胼胝体前部切开术治疗6例；17例同期行颅骨缺损修补术。术后继续正规服用抗癫痫药物。结果60例随访1—7年，EngelⅠ级21例，Ⅱ级32例，Ⅲ级4例，Ⅳ级3例，总有效率88．3％。具有精神症状的患者术后精神症状均明显缓解。出现暂时性轻偏瘫18例，永久性轻偏瘫2例，暂时性失语6例，颅内感染3例。结论手术是治疗外伤后晚期难治性癫痫的有效方法。术前准确定位致痫灶、术中ECoG监测及采取合适的术式是手术成功的关键。

Surgical treatment of late post-traumatic refractory epilepsy

Objective To investigate the precise location of epileptogenic foci,surgical technique and curative effect of surgery on late post-traumatic refractory epilepsy(LPTRE).Methods The epileptogenic foci was located by comprehensive analyzing data of neuro-imaging,video-electroencephalogram,clinical manifestation and intra-operative electrocorticogram(ECoG) in 68 patients with LPTRE.Only encephalodialysis foci(EF) were removed in 11 patients.EF and epileptogenic cortexes(EC) around EF were removed in 31.Removal of EF and EC around EF and the thermocoagulation of the epileptogenic functional cortexes or multiple subpial transection were performed in 20.EF and EC around EF were removed and the anterior corpus callosotomy was performed in 6.Results Of 60 patients followed up from 1 to 7 years,21 received Engel grade Ⅰ therapeutic outcome,32 grade Ⅱ,4 grade Ⅲ,and 3 grade Ⅳ.The effective rate was 88.3%.The psychiatric symptom was obviously improved in all the patients.The complications included temporary hemiparesis in 18 patients,permanent hemiparesis in 2,temporary aphasia in 6 and intracranial infection in 3.Conclusions The surgery is an effective method to treat LPTRE.The preoperative precise location of the epileptogenic focis,intra-operative ECoG monitoring and suitable surgical modality are the keys to good curative effect in the patients with LPTRE.