多种手术结合治疗顽固性癫痫

目的：对部分复杂的顽固性癫痫病人，将几种手术结合使用，并对其临床效果进行评价。方法：北京天坛医院手术治疗顽固性癫痫230例，其中对15例顽固性癫痫病人采用几种术式结合的方法。病人年龄9-43岁，平均18岁。病程4-40年，平均13年。发作形式为强直阵挛性发作、复杂部分性发作及失神，其中有8例存在两种发作形式。术前均服过抗癫痫药，病程后期同时服用2-3种抗癫痫药。这15例病人术前均行头皮脑电视频连续监测及头MRI检查，其中5例行头PET检查。手术在皮层脑电及深部电极监测下进行。13例行额颞开颅，胼胝体前部切开 颞前叶及海马切除 皮层热灼术；1例行额颞顶枕开颅，枕叶萎缩皮层切除 胼胝体前部切开 选择性海马切除 皮层热灼术；1全先行左额颞开颅，脚间池错构瘤及颞前叶及海马切除 皮层热灼术，术后癫痫减轻但仍发作且术后头皮脑电显示右额棘波明显，故又右额颞开颅，胼胝体前部切开 皮层热灼术。结果：术后无死亡及并发症。术手抗癫痫药物减少，术后12例服用一种抗癫痫药，3例服用两种抗癫痫药。术后随访3-12个月，14例无癫痫发作，1例癫痫发作两次（术前每天发作5-8次）。结论：多种手术结合治疗顽固性癫痫病人安全有效。

Combined operations for complex intractable epilepsy

Objective To study the combined several operations for complex intractable epilepsy during one surgery, including callosotomy, hippocampectomy, lesion resection and bipolar coagulation on functional cortexes (BCFC) and to evalute the surgical outcomes. Methods 230 seizure patients were surgical treated in Beijing Tiantan Hospital from 2000 to 2001, and 15 of them underwent combined operations. The patients ranged from 9 to 43 years old (average 18) with present history from 4 to 40 years (average 13). Different seizure patterns were observed in candidates, including tonic clonic seizure, complex partial seizures, and others. All of them were medicated with multiple anticonvulsants and had more than 2 or 3 kinds of medicines in the meantime before surgery. All patients were examined with one day video/EEG monitoring and MRI or PET.The choice of operation methods was based on multiple factors, including patient's neurological conditions, seizure patterns, radiographic findings, EEG investigations and the suspected etiology of the seizures. All operations were performed with the guidance of intraoprative electrocorticography. 13 patients underwent anterior callosotomy combined with anterior temporal lobectomy, hippocampectomy and BCFC, 1 occipital lobe resection combined with anterior callosotomy, hippocampectomy and BCFC, 1 basal cistern tumor resection and anterior temporal lobectomy combined with hippocampectomy, callosotomy and BCFC. Results Follow up from 3 to 12 months was available for all patients. No permanent complication and mortality occurred. The fact that seizure free in 14 patients indicated the surgical outcome was excellent. Conclusions For complex intractable epilepsy, the combined operations is effective on seizure control and as safe as regular seizure surgery.