脑功能区难治性癫痫的手术治疗

目的探讨开颅手术对功能区难治性癫痫的疗效。方法84例脑功能区难治性癫痫患者中,采用局部癫痫灶切除 多处软膜下横纤维切断术者29例,癫痫病灶切除 多处软膜下横纤维切断 前颞叶切除33例,癫痫病灶切除 多处软膜下横纤维切断 胼胝体前1/3切开22例。记录术后早期和9￣30个月临床观察及随访结果。结果术后早期16例患者出现一侧肢体肌力减弱,23例患者术后2￣3d出现失语,经治疗均在5￣10d内恢复。出院后随访9￣30个月,完全无发作65例,发作次数减少50%以上11例,发作减少50%以下6例,2例癫痫发作与术前相同。术前有14例言语功能障碍,17例有一侧肌力下降,术后均有不同程度的改善和恢复。结论术后疗效表明局部癫痫灶切除 多处软膜下横纤维切断术和癫痫病灶切除 多处软膜下横纤维切断 前颞叶切除的手术疗效优于癫痫病灶切除 多处软膜下横纤维切断 胼胝体前1/3切开手术方式的疗效。

Surgical treatment of intractable epilepsy in functional cortex

Objective To investigate the clinical therapeutic effect of craniotomy on intractable epilepsy in functional cortex. Methods Of 84 cases of intractable epilepsy in functional cortex, 29 patients were performened with epileptogenic lesionectomy and multiple subpial transection (MST); 22 patients with resection of the epileptogenic focus, MST and pre-l /3 corpus callosotomy, 33 patients with resection of the epileptogenic focus, MST and temporal lobectomy. Follow-up was performed in 72 patients for a duration of 9~30 months after operation. Results Unilateral dyspraxia was found in 16 patients in the early period of postoperation; transient aphasis in 23 patients had recovered in postoperative 5~10 d. Seizure disappeared completely in 65 cases, decreased moderately (>50%) in 11 cases, and decreased slightly (<50%) in 6 cases, the same as preoperation in 2 cases. Conclusion The clinical therapeutic effect is batter with epileptogenic lesionectomy, MST and with or without resection of the epileptogenic focus than with resection of the epileptogenic focus, MST and pre-l /3 corpus callosotomy.