单纯脑皮层电凝热灼术治疗功能区癫痫

目的 探讨单纯脑皮层电凝热灼术治疗功能区癫痫的方法 与疗效.方法 回顾性分析单纯应用脑皮层电凝热灼术治疗的15例功能区癫痫患者,观察术后并发症及治疗效果.结果 7例出现对侧肢体不同程度偏瘫,2例热灼颞叶及颞枕皮层患者无语言视力等功能缺失.术后无一例患者颅内出血及感染.Engel癫痫术后评分,其中Ⅰ级6例,Ⅱ级2例,Ⅲ级5例,Ⅳ级2例.结论 单纯低功率电凝热灼功能区致痫灶,操作简便,安全有效.     

单纯脑皮层电凝热灼术治疗功能区癫痫

Objective To investigate the surgical methods and effectiveness of pure electrocoagulation on cerebral cortex for epilepsy involving eloquent areas. Method 15 patients who underwent pure electro - coagulation on cerebral cortexes for epilepsy involving eloquent areas from 2002 to 2008 were evaluated retrospectively. The seizure outcome and complications were described. Results Seven patients had hemiparesis after operation. All neurological deficits were temporary in the sense that they ultimately did not result in a deficit that would be noticed during a standard clinical examination. There were no subdural hemorrhage and infection. Six of the 15 patients were Engel Class Ⅰ , two were Class Ⅱ , five were Class Ⅲ, and two were Class Ⅳ. Conclusions Seizures could be effectively controlled through pure electrocoagulation on cerebral cortexes for epilepsy involving eloquent areas, and minimal neurological function was impaired.     

单纯脑皮层电凝热灼术治疗功能区癫痫

Objective To investigate the surgical methods and effectiveness of pure electrocoagulation on cerebral cortex for epilepsy involving eloquent areas. Method 15 patients who underwent pure electro - coagulation on cerebral cortexes for epilepsy involving eloquent areas from 2002 to 2008 were evaluated retrospectively. The seizure outcome and complications were described. Results Seven patients had hemiparesis after operation. All neurological deficits were temporary in the sense that they ultimately did not result in a deficit that would be noticed during a standard clinical examination. There were no subdural hemorrhage and infection. Six of the 15 patients were Engel Class Ⅰ , two were Class Ⅱ , five were Class Ⅲ, and two were Class Ⅳ. Conclusions Seizures could be effectively controlled through pure electrocoagulation on cerebral cortexes for epilepsy involving eloquent areas, and minimal neurological function was impaired.     

病灶切除结合周围痫灶皮层热灼治疗继发性癫痫(附18例报告)

目的回顾性分析继发性癫痫的外科治疗方法及效果。方法自2003年6月至2011年5月对18例继发性癫痫患者进行病灶切除,根据术中皮层脑电图监测结果,对病灶周围脑皮层实施热灼。结果 18例病人,术后随访6个月至8年,Engel分级Ⅰ级13例,Ⅱ级3例,Ⅲ级1例,Ⅳ级1例。结论病灶切除结合脑皮层热灼治疗继发性癫痫临床操作简便,可有效控制癫痫发作。     

皮层热灼联合多软膜下横切治疗癫痫的临床观察

癫痫患者中20%构成难治性癫痫(又称顽固性癫痫),其外科治疗总有效率可达65%￣97%[1]。我科36例此类患者采用联合性皮层热灼术(BCFC)及多处软膜下横切术(MST)治疗,近期随访癫痫控制效果良好,无并发症。现将结果报告如下。一、资料和方法1.临床资料:我科自2003年10月至2005年11月     

胼胝体切开联合皮层热灼术治疗难治性癫痫(附82例回顾分析)

目的 探讨胼胝体切开联合皮层热灼术治疗难治性癫痫的手术方式与治疗效果.方法 82例难治性癫痫行胼胝体切开术治疗,其中18例行单纯胼胝体切开、33例行胼胝体切开 致痫皮层低功率电凝热灼、31例行单侧致痫灶切除 胼胝体切开 致痫皮层低功率电凝热灼.术后随访6个月～2年.结果 11例(13.4%)癫痫发作完全消失;41例(50%)癫痫发作次数显著减少;16例(19.5%)癫痫发作程度减轻;8例(9.8%)无明显改善;6例(7.3%)发作略有加重;无死亡病例.手术后疗效以Wilsion标准评判,优良率为83%.结论 部分性发作的癫痫患者,最可靠的治疗方法是致痫灶的切除,但对于全面性发作的病人,其致痫区往往比较广泛而无法切除,胼胝体切开可以阻断两侧半球间痫样放电的传播,联合皮层热灼术可以减少发作频率、减轻发作程度和改变发作形式,提高治疗效果.     

术中癫痫诱发试验联合皮层热灼治疗胶质瘤所致癫痫的临床研究

目的 探讨术中癫痫诱发试验联合皮层热灼治疗胶质瘤所致癫痫的方法和效果.方法 连续选择以癫痫为主要临床表现的胶质瘤患者11例,在常规气管插管全麻下首先行肿瘤显微手术切除,然后在皮层脑电图的监测下,对癫痫灶皮层进行低功率双极电凝热灼.待癫痫波完全消失后,采用患者唤醒、过度换气和静脉注射氟马西尼联合进行癫痫诱发试验,同时给予少量肌松药防止抽搐发作.对诱发出的棘、尖波再给予皮层热灼直至完全消失.手术后不再使用镇静药物和抗癫痫药物,并对患者进行术后追踪随访,随访时间为18～20个月.结果 诱发试验能够明显增加脑皮层的电活动和癫痫波的出现频率,而皮层热灼的作用恰好相反.所有患者全部安全度过围手术期,且一般状态恢复较快.除1例在术后接受放疗期间出现一过性右上肢抽搐,又给予抗癫痫药物治疗外,其余患者均未发现癫痫复发的征象.结论 术中癫痫诱发试验联合皮层热灼是治疗胶质瘤所致癫痫的有效方法,并且安全可靠,有必要进行深入的研究.     

脑皮层热灼治疗功能区癫痫的可行性研究

目的（１）研究猴脑运动区皮层经电凝热灼后其功能及病理学改变。（２）研究低强度电凝热灼对癫痫患者不同部位脑皮层的损伤程度,探讨应用大脑皮层横行纤维破坏来控制功能区顽固性癫痫发作的可行性。方法（１）用电凝功率８～１２Ｕ热灼猴中央前回运动区皮层,饲养不同时间,观察动物的行为、ＭＲＩ、组织病理学及超微结构的改变。（２）采用双极电凝输出功率为低于８Ｕ,对癫痫患者的脑皮层进行热灼,并切除热灼皮层进行急性病理学分析。结果（１）饲养期间动物的饮食、活动等均同术前;处死前的脑部ＭＲＩ检查正常;脑组织的病理学表现主要为浅表皮层（Ｉ－Ⅱ）的热凝损伤及胶质细胞增生,而深部皮层结构正常;电镜下主要为退变神经元,饲养６个月后动物的病变组织逐渐恢复正常。（２）癫痫患者脑浅表皮层（Ⅰ－Ⅱ）有不同程度的热凝损伤,其下相邻皮层的神经元固缩,核深染,而深层（ＩＶ－ＶＩ）组织结构正常。结论提示热灼可使多处浅皮层内的横行纤维变性,从而可能阻止癫痛放电水平方向的同步化和传播,同时该皮质的正常功能仍可能保留。因此热灼的治疗方法安全可行,可在临床上进一步试用。     

立体定向病灶切除联合皮层热灼术治疗起源于中央区的癫

目的探讨立体定向病灶切除联合皮层热灼术治疗起源于中央区的癫(癎)的疗效.方法对27例以癫(癎)为首发表现的起源于中央区的癫(癎)病人采用立体定向开颅手术,切除病灶前先行皮层电极描记,确定癫(癎)波的范围,然后在显微镜下切除病灶,再次描记确定残余的癫(癎)波的位置,并使用皮层热灼术进行皮层热灼,直到癫(癎)波消失为止.结果27例病人中胶质瘤13例,脑囊虫病7例,脑膜瘤3例,皮层发育不全2例,海绵状血管瘤1例,炎症1例.手术中在切除病灶前使用皮层电极描记出癫(癎)波,病灶切除后在病灶周围仍残余有癫(癎)波,使用皮层热灼术热灼后癫波消失.27例病人手术后25例未再有癫(癎)发作,2例手术后一周内有癫(癎)发作一次,以后未再有癫(癎)发作.26例病人未出现神经功能损害症状加重,一例短期内出现偏瘫加重,经过对症处理后好转.结论立体定向病灶切除联合皮层热灼术治疗起源于中央区的癫(癎)是一种侵袭性小、疗效佳的手术方法.     

癫痫病人海马电凝热灼术中电凝功率与海马传导纤维病理改变相关性分析

目的 观察不同功率的海马电凝热灼术（HEC）损伤海马浅层所引起的海马横行传导纤维的病理形态学改变,探讨最佳功率应用于热灼海马分子层来控制颞叶癫痫（TLE）发作的可行性,为HEC治疗TLE寻求可靠的理论依据。方法 对20例TLE病人的海马进行电凝热灼,输出功率为3、5、7 W;然后切除海马。对切除的海马进行病理形态学观察分析,并对比热灼损伤深度。结果 热灼后海马的病理形态学表现主要分为三层:浅表分子层的热凝固损伤;损伤部位分子层的水平神经元核固缩;损伤部位与正常脑组织之间的水肿带;而锥体细胞及齿状回颗粒细胞层结构相对正常。4例热灼功率3 W,平均损伤深度为0.335 mm;7例为5 W,平均损伤深度为0.556 mm;9例为7 W,平均损伤深度为1.290 mm。锥体细胞深度在表面以下1.786~1.995 mm,平均1.836 mm。结论 HEC可使海马分子层的横行纤维变性、断裂,热灼功率7 W效果最佳,不但可阻止癫痫放电水平方向的同步化和传播,同时保留海马的记忆功能。     

微波热凝后骨骼肌体积及功能的变化

背景：微波利用其热效应在医学领域得到广泛应用,经微波热凝作用后造成局部组织凝固性坏死,坏死部位由纤维组织修复。但是微波热凝是否能产生缩容效果运用于口腔临床,目前经检索国内外尚未见报道。目的：观察微波热凝骨骼肌后肌肉体积和功能的改变,探讨微波热凝用于骨骼肌体积缩小的可能性。　方法：20 只新西兰大白兔暴露双侧胫骨前肌,采用2 450 MHz微波治疗仪以70 W微波热凝一侧胫骨前肌20 s,另一侧不做微波热凝作对照。分别于热凝后24,48 h和1,8周,随机各处死5只兔,测量双侧胫前肌体积变化,8周处死动物前,行肌电生理检测双侧胫前肌的肌动力。　结果与结论：微波热凝后24,48 h骨骼肌体积增大[(5.82±0.93),(6.04±0.47) mL],48 h体积最大,1周后肌肉体积开始缩小[(4.90±0.80) mL],8周后体积[(4.27±0.67) mL]缩小23.6%;肌电生理检测显示对照组与热凝组潜伏期分别为(1.765±0.393),(1.760±0.394) ms,波宽分别为(6.273±0.808),(6.259±0.773) ms,两组之间传导速度及波宽差异无显著性意义(P > 0.05)。结果证实微波热凝后48 h内肌肉体积增大,随后体积减小,骨骼肌可保持肌功能。     

Effect of macular and peripheral retina coagulation on photosensitive epilepsy in the forebrain bisected baboon, Papio papio

The effects of macular and peripheral retina coagulation were examined in photosensitive baboons, Papio papio (PP), with or without forebrain bisection. The temporal part of the macula and surrounding retina of the left eye were coagulated with an Argon laser and later confirmed histologically. In forebrain nonbisected baboons, intermittent light stimulation of the operated eye produced bisymmetrical and bisynchronous spikes and waves and self-sustained seizures. In forebrain-bisected baboons intermittent light stimulation of the operated eye produced spikes and waves and self-sustained seizures localized to the contralateral hemisphere. Subsequent stimulation of the nonoperated eye in the same animal produced spikes and waves and seizures either bilaterally or only in the opposite hemisphere when stimulation took place during the postictal silent period in the first hemisphere. In both cases, the tonic phase of the seizure was always bilateral but asymmetrical as shown by electromyographic recordings. Based on these data, it has been hypothesized that the tonic phase is mediated, in part, through crossed interreticular pathways, by one or both cerebral hemispheres. However, data are also compatible with a possible origin of the tonic phase of the seizure being partly localized in the medial frontal cortex. Results demonstrated (1) the usefulness of laser coagulation of the temporal portion of the macula and retina for the study of the functional independence between two cerebral hemispheres, (2) the critical role of the corpus callosum (CC) in bisynchronization and generalization of the intermittent light stimulation (ILS)-induced seizure, (3) independent excitability of each cerebral hemisphere by the ILS, and (4) the critical role of cortical visual afferents for inducing epileptic phenomena in this species.     

动脉瘤性SAH后症状性脑血管痉挛与高凝状态相关性及防治研究

目的:探讨动脉瘤性SAH后症状性脑血管痉挛与病人外周血清高凝状态的相关性,同时观察应用丹参注射液对血液高凝状态的影响。方法:60例动脉瘤性蛛网膜下腔出血(SAH)病人,出现症状性脑血管痉挛38例,症状性脑血管痉挛组随机分为丹参治疗组和非丹参治疗组。所有病人分别在住院时、3天、7天、14天、21天,进行周围血中FDP和D-dimer含量的测定并进行动态观察。结果:症状性脑血管痉挛组病人FDP和D-dimer的含量在住院后各时间段明显高于非症状性脑血管痉挛组(P<0.01),住院后第14天、21天丹参治疗组FDP和D-dimer的含量明显低于非丹参治疗组(P<0.05)。症状性脑血管痉挛组中,丹参治疗组病人的预后明显优于非丹参治疗组。结论:动脉瘤性SAH引起症状性脑血管痉挛与血粘稠度增高有明显关系。丹参注射液可明显降低血粘稠度,促进脑血液循环对改善症状性脑血管痉挛的脑缺血症状有明显的治疗作用。     

Focal cortical dysplasias in eloquent cortex: functional characteristics and correlation with MRI and histopathologic changes

PURPOSE: Focal cortical dysplasia (CD) is increasingly recognized as a common pathologic substrate of medically intractable epilepsy. As these lesions are often localized in the frontal lobe (therefore in potentially eloquent cortex), an understanding of the functional status of the involved region(s) and of its anatomic and pathologic correlates is of prime importance. The purpose of this study is to assess the function of focal CD in relation to magnetic resonance imaging (MRI) and histopathologic features. METHODS: Eight patients operated on for medically intractable epilepsy with histologically proven focal CD involving putative eloquent cortex in the frontal lobe (perirolandic and Broca's areas) were included in the study. Functional regions (motor and language) and epileptogenic areas were assessed by extraoperative electrocorticographic recording and electrical cortical mapping. Cortical functions were correlated with the extent of epileptogenicity on electrocorticographic recordings, MRI features, and histologic characteristics. RESULTS: Language or motor areas were colocalized with epileptogenic regions (n=6 of 8, 75%), but were not mapped in regions of increased signal on fluid-attenuated inversion recovery (FLAIR) MRI (when they were identified) on preoperative MRI (n=5 of 5, 100%). Histologically, balloon cells were almost exclusively found in nonfunctional regions with FLAIR MRI abnormalities. When resected, regions of motor cortex were characterized by cortical dyslamination, columnar disorganization, and dysmorphic neurons, but were devoid of balloon cells. CONCLUSIONS: We found an absence of language or motor functions in perirolandic and Broca's areas that showed decreased epileptogenicity, histopathological evidence of CD with balloon cells and FLAIR MRI signal increase. Language and motor functions were present in epileptogenic and dysplastic areas with no balloon cells and no FLAIR signal abnormalities. These findings have implications on options for epilepsy surgery in patients with CD.     

急性脑梗死患者炎症因子、血凝状态的变化

目的 探讨急性脑梗死患者血小板功能、凝血与纤溶功能及炎症因子的变化情况。方法 采用血凝仪和全自动生化分析仪测定106例急性脑梗死患者APTT、FIB、D-二聚体、hs-CRP、IL-6、TNF-α、PAgT等指标水平,并与100名健康者进行对照。结果 急性脑梗死组患者凝血功能中APTT值明显缩短,FIB值和D-二聚体值明显增大,炎症因子中IL-6值、hs-CRP和TNF-α值明显升高,PAgT值增大,与对照组比较均有明显差异(P<0.01)。重度脑梗死组与中度和轻度脑梗死组比较,中度脑梗死组与轻度脑梗死组比较,各项检查值均明显改变(P<0.05)。采用多联指标分析,四项检测指标联合和五联项检测指标联合进行急性脑梗死预测与诊断,其灵敏性(100%,97%)、特异性(98%,100%)、阳性预测值(98%,100%)和阴性预测值(100%,97%)较理想。结论 检测APTT值、FIB值、D-二聚体值、IL-6值、hs-CRP、TNF-α值和PAgT值对急性脑梗死的诊断和预后判断有一定的临床意义。     

Pathology and neuroimaging of coagulation necrosis in cerebral infarcts

Tissue which has undergone coagulation necrosis (CN) after cerebral infarct is firmer than normal and sharply delimited, and these abnormalities may persist for months or years. This report examines some unusual features, visible on a computed tomography (CT) scan, in two autopsy verified CN cases. In the first case, a ring-shaped enhancement was visible 3 months after the onset of cerebral infarction, which may reflect blood flow in small vessels associated with the collagen capsule. In the second case, a lesion was observed showing hypo-intensity on a T2-weighted image and hyperintensity on a T1-weighted image 4 years after onset. These changes could be attribut-able to calcium or cholesterin deposition or changes in the collagen capsule. Because CN associated with cerebral infarct is not as rare as previously reported, care should be taken in the interpretation of CT findings which exhibit these features.