顽固性癫痫致痫灶的综合定位和外科治疗

目的探讨顽固性癫痫致痫灶定位方法和术式选择。方法综合运用神经影像学、脑电图和SPECT等方法,对23例顽固性癫痫患者进行致痫灶定位和外科手术治疗,并评价其疗效。结果23例患者中,致痫灶定位VEEG与ECoG一致者19例,占82.6%;MRI与ECoG一致者16例,占69.7%;SPECT与ECoG一致者5例,达100%。采用癫痫灶切除、前颞叶切除加杏仁核和大部分海马切除,低功率皮层热灼等多种术式联合治疗,经0.5~2.3年的随访,满意8例,显著改善7例,良好5例,效差3例,总有效率为87.0%。结论对于顽固性癫痫,多种检查方法联合应用能准确定位致痫灶,多种术式联合治疗可以取得良好效果。

Comprehensive localization of epileptogenic focus and surgicaltreatment of refractory epilepsy

Objective: To explore the localization of epileptogenic focus and selection of appropriate surgical methods in refractory epilepsy. Methods: Epileptogenic foci were located by the comprehensive application of neuro-imaging, electroencephalogram and SPECT in 23 patients with refractory epilepsy. Surgical procedures were taken and the therapeutic effects were followed up. Results: In 19 out of 23 patients 82.6%, the localization of epileptogenic foci by VEEG was consistent with that by ECoG , while in 16 out of 23 patients the localization by MRI was consistend with that by ECoG. The localization of epileptogenic foci of 5 patients by SPECT was consistent with that by ECoG. The patients were treated with various procedures, including epileptogenic focus elimination, anterior temporal lobectomy and amygdalo-hippocampectomy and low power bipolar coagulation. All patients were followed up from 6 months to 2.3 years postoperation, satisfactory outcome was found in 8 cases, marked improvement in 7 cases, improvement in 5 cases, slight improvement in 3 cases. The total effective rate was 87.0% .Conclusion: The combined various examinations can precisely locate epileptogenic focus. Good effects may be obtained by combined various surgical procedures for refractory epilepsy.