半球切开术治疗顽固性癫痫

目的 对于单侧大脑半球弥漫性病变引起的难治性癫痫,可以用大脑半球切除术或切开术治疗.本文总结作者最近进行的3例大脑半球切开术,同时进行了相应的文献复习.方法 3例难治性癫痫,男2例,女1例,年龄分别为7、11、和15岁.均为一侧半球病变,其中实施大脑半球完全切开术2例,后象限切开术1例.手术的目的是完全孤立致痫区域.结果 3例患者分别随访22、22、12个月,其中EngelⅠ A 2例,EngelⅡ B 1例.无长期神经功能障碍或死亡病例.结论 应用神经纤维离断技术进行大脑半球切开,可获得与切除术相同的控制癫痫的良好效果.     

改进的解剖式半球切除术治疗顽固性癫痫

目的 探讨大脑半球切除术治疗顽固性癫痫的临床效果。方法 对36例顽固性癫痫患者行改进的解剖式大脑半球切除术，并随访观察其临床治疗效果。结果 36例顽固性癫痫患者的癫痫发作，均得到有效控制，其中34例(94．44％)患者的癫痫发作得到完全控制。同时30例(83．33％)病人的神经功能缺失症状并未加重，其中5例(13．89％)比手术前有不同程度好转。所有患者的神经心理学评价均较术前有不同程度的提高。结论 对大脑半球广泛性病变伴顽固性癫痫的病人，行病侧大脑半球切除术，可使癫痫发作得到良好的控制，使患者的神经心理学评价得到改善。     

小儿顽固性癫痫的外科治疗

目的回顾性分析2002年6月至2007年6月间,在我院接受手术治疗的142例儿童顽固性癫痫患者的手术经验。方法术前评估和术中脑电检查显示为局灶性改变者行致痫灶切除或脑叶切除和（或）多软膜下横纤维切断（MST）。检查提示一侧半球为主多灶性改变者,术中行多脑叶切除联合MST和/或胼胝体部分切开。结果本组随访1～5年,平均3年。142例中有65例获得I级（Engel分级）,34例获得Ⅱ级,25例为Ⅲ级预后。有效率87.3%,效果优良率为69.7%。平均总智商（FIQ）从术前的65.4分提高到80.9分,癫痫病程和术前药物难治的时间越短,智商改善越明显。本组有16例出现暂时性的并发症,无手术死亡。结论对小儿顽固性癫痫患者,只要病例选择适当,手术方式合理,其手术效果是令人满意的,对这类患儿的早期外科干预,不仅可以有效地控制癫痫发作,而且可改善已有的智力损害和减少生活残疾。     

切除癫痫灶治疗癫痫

我科从1992年初至1993年8月采用皮层脑电图监测下对药物难以控制的癫痫病人手术治疗29例,现报告如下。 1 临床资料 29例中,男18例,女11例。年龄8～42岁,平均22.4岁。病程3月～18年,54％的病程超过3年。癫痫发作形式:大发作10例;大发作加精神运动性发作5例;大发作加局限性发     

选择性海马杏仁核切除治疗顽固性颞叶癫痫及随访

选择性海马杏仁核切除术是治疗顽固性颞叶癫痫引人注目的手术方法之一 ,由于海马杏仁核位于颞叶深部 ,在手术暴露时往往会损伤颞叶皮层某些功能。作者从 1 996年 9月至 1 997年 7月采用经颧弓颞底入路 ,选择性海马杏仁切除治疗 6例颞叶癫痫 ,取得了比较满意的结果 ,现报告如下。临床资料男性 2例 ,女性 4例。年龄 1 8～ 45岁 ,平均34.4岁。病程 4～ 8年 ,平均 5.4年。所有病人均为神经内科医师确诊 ,并经过 2年以上正规药物治疗 ,癫痫控制效果不佳 ,每月癫痫发作在 4次以上 ,并已影响生活和工作者。其中癫痫灶位于左侧颞叶者 4例 ,癫痫灶位…     

皮质电图监测下顽固性癫痫灶切除6例报告

分析了６例癫痫灶切除手术病例，结果近期全部有效，无神经病学并发症，认为术前完善的监测评估，术中在反复皮层电图监测下尽量作癫痫灶切除，是提高疗效的重要环节。     

脑电监测下痫灶切除治疗顽固性癫痫

癫痫是一种常见病 ,其患病率约为 0 .4‰ ,虽有多种治疗癫痫的药物 ,但仍有 2 0 %～ 2 5 %的癫痫病人非药物所能控制。因此 ,近年来采用手术方法治疗癫痫已渐为人们所接受 ,并取得较好疗效。我院自 1 998年 9月～ 2 0 0 1年 1月采用脑电监测下手术治疗 8例顽固性癫痫 ,现初步总     

Hemispherectomy for intractable epilepsy in adults: the first reported series

Hemispherectomy for intractable unihemispheric epilepsy (IUE) has long been established in pediatric patients. This study reports the first series examining hemispherectomy exclusively in adult patients (>18 years old). Nine adults with IUE underwent hemispherectomy at the University of Minnesota. All patients had unilateral hemiplegia and visual field loss. Seven patients (77.8%) were Engel class I/II at last follow-up. Five (83.3%) of the six patients with >30 years of follow-up were seizure free. No surgery-related mortality, hydrocephalus, or superficial cerebral hemosiderosis occurred. Hemispherectomy is an effective procedure in appropriately selected adult patients, resulting in excellent long-term seizure control and no mortality.     

大脑半球切除术治疗半侧巨脑症合并顽固性癫痫

目的　总结半侧巨脑症合并顽固性癫痫病人行大脑半球切除术治疗的临床效果。方法　经MRI检查确诊 10例半侧巨脑症病人 ,伴有顽固性癫痫 ,头颅增大不对称 ,颅腔扩大 ,偏瘫 ,不同程度的精神运动发育迟缓 ,都是一侧大脑半球损害。行病侧大脑半球切除术。结果　 7例癫痫发作完全控制 (70 % ) ,3例基本控制 (30 % )。精神运动症状 ,语言 ,肢体运动及行为均有较明显改善。结论　大脑半球切除术治疗半侧巨脑症合并顽固性癫痫 ,可以解除患者的癫痫发作及长期药物依赖 ,改善脑的功能 ,是一种有效的治疗方法     

Hemispherectomy for intractable seizures in children: a report of 58 cases

Fifty-eight children who underwent anatomical, functional, or modified anatomical hemispherectomy for intractable seizures from 1986 to 1995 were evaluated for seizure control, motor function, and complications. Age at surgery ranged from 0.3 to 17.3 years (median 2.8 years). Twenty-seven anatomical, 27 functional, and 4 modified anatomical hemispherectomies were performed. Seizure control and motor function in the 50 patients with more than 1 year follow-up revealed a 90% or better reduction in seizure frequency in 44/50 (88%) overall: 19/22 (86%) anatomical, 23/26 (89%) functional, and 2/2 modified anatomical. Motor function of the preoperatively hemiparetic extremities was improved or unchanged postoperatively in 38/50 (76%) of the patients. Complications included one intraoperative death, one late death from shunt obstruction managed elsewhere, late postoperative seizure breakthrough requiring reoperation and further disconnection in 5/27 functional hemispherectomy patients, mild cerebrospinal fluid infections in 3/27 anatomical hemispherectomy patients, and hydrocephalus requiring shunting in 3/27 functional hemispherectomy patients. A review of the literature and comparison of techniques is presented.     

大脑半球离断术治疗儿童难治性癫痫

目的 探讨大脑半球离断术治疗儿童难治性癫痫的手术方法及疗效.方法 2007年8月至2011年10月北京三博脑科医院进行12例大脑半球离断手术.经侧裂半球离断术1例,经纵裂半球离断并颞叶切除4例,中央区造瘘半球离断并颞叶切除5例,颞叶、岛盖切除岛周半球离断术2例.手术年龄平均7.6岁(2.1 ～11.9岁).结果 术后随访0.5 -4.5年,Engel Ⅰ级10例,EngelⅡ级1例,Engel Ⅲ级1例.术后因离断不完全再次行离断手术1例.术后患者的认知及生活能力较术前提高,无脑积水等严重神经功能损伤及死亡病例.结论 大脑半球离断术治疗儿童半球性难治性癫痫完全缓解率83％ (10/12),手术疗效确定,是治疗儿童半球病变性癫痫的安全、有效的方法.     

Hemispherectomy for catastrophic epilepsy in infants

PURPOSE: To report our experience with hemispherectomy in the treatment of catastrophic epilepsy in children younger than 2 years. METHODS: In a single-surgeon series, we performed a retrospective analysis of 18 patients with refractory epilepsy undergoing hemispherectomy (22 procedures). Three different surgical techniques were performed: anatomic hemispherectomy, functional hemispherectomy, and modified anatomic hemispherectomy. Pre- and postoperative evaluations included extensive video-EEG monitoring, magnetic resonance imaging, and positron emission tomography scanning. Seizure outcome was correlated with possible variables associated with persistent postoperative seizures. The Generalized Estimation Equation (GEE) and the Barnard's exact test were used as statistical methods. RESULTS: The follow-up was 12-74 months (mean, 34.8 months). Mean weight was 9.3 kg (6-12.3 kg). The population age was 3-22 months (mean, 11.7 months). Thirteen (66%) patients were seizure free, and four patients had >90% reduction of the seizure frequency and intensity. The overall complication rate was 16.7%. No deaths occurred. Twelve (54.5%) of 22 procedures resulted in incomplete disconnection, evidenced on postoperative images. Type of surgical procedure, diagnosis categories, persistence of insular cortex, and bilateral interictal epileptiform activity were not associated with persistent seizures after surgery. Incomplete disconnection was the only variable statistically associated with persistent seizures after surgery (p<0.05). CONCLUSIONS: Hemispherectomy for seizure control provides excellent and dramatic results with a satisfactory complication rate. Our results support the concept that early surgery should be indicated in highly selected patients with catastrophic epilepsy. Safety factors such as an expert team in the pediatric intensive care unit, neuroanesthesia, and a pediatric epilepsy surgeon familiar with the procedure are mandatory.     

Cognitive changes following surgery in intractable hemispheric and sub-hemispheric pediatric epilepsy

Objectives  

The objectives were to study the short and longitudinal changes in the cognitive skills of children with intractable epilepsy after hemispheric/sub-hemispheric epilepsy surgery.     

多脑叶切除联合其他术式治疗半球顽固性癫癎(附18例报告)

目的探讨运用多脑叶切除联合多软膜下横纤维切断术(MST)或／和胼胝体部分切开术治疗脑电图 提示为单侧半球为主的多脑叶或半球弥漫性癎灶患者的手术疗效。方法 回顾性总结、分析采用多脑叶切除联合 MST或／和胼胝体部分切开术所治疗的具有半球(为主)多脑叶或半球弥漫性癎灶的18例重型顽固性癫癎患者。结 果本组术后随访1～5年,平均2年。疗效按Engel的标准评定,I级(术后即无癫癎发作)11例;Ⅱ级(每年仅1 ～2次发作)3例;Ⅲ级(发作频率减少75％以上)2例;Ⅳ级2例,总有效率16／18;效果优良14／18,无于术死亡。结 论采用多脑叶切除联合其他术式治疗具有半球(为主)多脑叶或弥漫性癎灶的重型顽固性癫癎具有疗效好、并发 症相对较少等优点,比大脑半球切除术具有更广泛的适应证。     

Corpus callosotomy for control of intractable epilepsy in children

Cerebral commissurotomy has often been reported to control seizures in patients suffering from intractable epilepsy. However, in adults, division of the corpus callosum alone has been shown to be equally effective while considerably reducing the surgical morbidity. The present study of nine epileptic callosotomized patients suggests that callosal section can also be performed successfully and safely in children. Neurologic and concomitant psychological improvements are described.