顽固性癫痫的精确定位和微创治疗技术（附338例报告）

目的 研究顽固性癫痫的外科治疗方法。方法 联合应用三维痫灶精确定位诊疗计划系统及影象学检查对338例顽固性癫痫患者进行术前、术中致痫灶三维精确定位，采用癫痫微创外科技术(多处软膜下扇形横切术、胼胝体前部潜行切开术、选择性前颞叶切除术、神经导航下显微病灶切除术)切除致痫灶、阻断传导纤维以治疗顽固性癫痫。结果 将术前定位结果与术中64导皮层电极及8导深部电极检测结果相比较，证实术前定位准确可靠；必要的影象学检查有助于痫灶定性定位诊断及治疗方案设计；随访疗效评估总有效率达98．1％，其中疗效Ⅲ级以上达74．8％；术后正常神经功能保护良好，无明显后遗症。结论 联合应用三维痫灶精确定位诊疗计划系统和影象学检查，对致痫灶定位准确；癫痫微创外科技术治疗顽固性癫痫安全有效。

Precise localization of the epileptogenic foci for surgical treatment of refractory epilepsy with minimal invasion.

OBJECTIVE: To study the surgical approach for the treatment of medically refractory epilepsy. METHODS: In 338 cases of refractory epilepsy, precise localization of the epileptogenic focus was achieved with the help of three-dimensional epileptogenic focus localization and treatment planning systems also assisted by imaging modalities before and during the operation. The foci were resected and the conduction fibers were treated with minimum damage methods of surgical treatment of epilepsy. RESULTS: Preoperative focus localization was verified by detection with 64-channel ECoG and 8-channel depth electrodes during the operation, and the imaging modalities proved helpful to the diagnosis and subsequent treatment planning. The follow-up of the patients lasting for 1 to 4 years postoperatively found a total efficacy rate of 98.1%, and up to 74.8% of the cases obtained class I to III therapeutic effects, with satisfactory nerve function preservation and no obvious sequela. CONCLUSION: Three-dimensional focus localization and treatment planning system in conjunction with the imaging modalities yields precise epileptogenic focus localization, and the surgical approach we adopted is safety and effective for treating refractory epilepsy with minimal invasion.