难治性癫痫显微外科治疗的疗效分析

目的 报道应用显微外科治疗难治性癫痫的临床效果。方法应用三维痫灶定位诊疗计划对163例顽固性癫痫患者进行术前、术中致痫灶三维精确定位，然后在显微镜下采用几种术式结合的方法手术处理致痫灶、致痫网。术后随访1～2年，回顾性分析显微外科手术治疗的临床效果。结果结果发现术后癫痫发作完全消失52例（31．90％），发作显著改善83例（50．92％），改善较好10例（6．13％），改善较差15例（9．20％），发作无改善3例（1．84％），手术总有效率为88．96％，无效率为11.04％，术后88．96％以上的患者生活质量均有一定程度的提高。结论应用显微外科技术切除癫痫病灶可以明显减少术后并发症，提高临床疗效。     

儿童脑神经节细胞瘤伴癫的显微外科治疗

目的：探讨神经节细胞瘤（Ganglioglioma,GG)伴癫痫的临床表现及外科治疗方法。方法：回顾性分析9例GG伴癫痫的病例,肿瘤位于颞叶6例,额叶2例,枕叶1例,均进行术前脑电图及影像学检查,并在脑电图监测下行肿瘤加致痫灶切除术。结果;在获随访8例中,完全不发作6例,好转2例。结论：GG伴癫痫应尽早手术治疗,脑电图监测行致痫灶加肿瘤切除效果良好。     

颞叶癫痫的术前评估与手术治疗

目的对行手术治疗的顽固性颞叶癫痫患者术前进行综合评估,明确致痫灶部位,实施个体化手术方案。方法对26例颞叶癫痫患者术前进行视频脑电图(V-EEG)、磁共振成像(MRI)检查,综合分析检查结果,制定相应手术方案。术中行皮层脑电描记,术后对切除组织进行病理检查,并对患者进行手术后随访。结果V-EEG、MRI两种检查定位结果完全一致的有21例。24例患者(92.3%)术后癫痫发作完全或部分缓解,2例患者(7.6%)无明显缓解。结论对顽固性颞叶癫痫患者术前进行综合评估,对制定合理的手术方案,提高治愈率有重要指导意义。     

颞叶新皮质癫痫的手术方式探讨

目的分析总结颞叶新皮质癫痫患者临床特征、术前评估、手术方法和疗效。方法对6例颞叶新皮质癫痫患者（经术中皮层电极和深部电极描记证实），回顾性研究其术前临床表现特点、电生理学、影像学（MRI、SPECT）定位、术中皮层电极和深部电极描记、手术方式（标准前颞叶切除＋致痈灶皮质热灼术＋杏仁核海马部分切除术）以及随访6个月-2年的疗效观察。结果6例颞叶外侧癫痫术后疗效，根据谭启富等学者的标准分类：Ⅰ级3例，Ⅱ级1例，Ⅲ级1例，Ⅳ级1例。Ⅴ级0例。病理报告：胶质增生4例；微小血管畸形1例；无异常发现1例。术后并发症：1例近记忆功能障碍，1例不全性感觉失语，1例对侧上象限盲；无手术致残和死亡。结论术前根据临床表现特点、电生理学、影像学和SPECT准确定位，术中根据ECoG及深部电极发现，联合采取不同术式（强调常规均行海马杏仁核部分切除术）彻底切除痫灶，对颞叶新皮质癫痫可达到良好的治疗效果，且无严重手术并发症。     

显微外科治疗难治性颞叶癫痫102例

目的探讨显微外科治疗难治性颞叶癫痫的疗效。方法2005年1月～2011年12月通过术前综合评估定位,术中额颞翼点切口,显微外科切除致痫灶治疗难治性颞叶癫痫102例。采用Engel标准评定术后疗效;将自理能力、学习能力、工作能力3个指标作为生活质量的评定标准,对比术前及术后1年9月各项指标的差异。结果102例随访1年9个月～7年,术后无因该病死亡及严重手术并发症发生。术后1年Engel评定疗效：I级61例（59．8％）发作完全消失,Ⅱ级17例（16．7％）极少发作,Ⅲ级13例（12．7％）发作减少75％以上,Ⅳ级无效11例（10．8％）,有效率89．2％（91／102）,优良率76．5％（78／102）。术后1年9个月患者自理情况：不能自理6例,部分自理32例,完全自理64例,术前分别为21、67、14例,术前后比较有统计学差异（Z=-7．001,P=0．000）。67例青少年及儿童患者学习能力术前后有统计学差异（Z=-3．747,P=0．000）;35例成人患者工作能力术前后有统计学差异（Z=-2．564,P=0．010）。结论显微外科治疗难治性颞叶癫痫患者生活质量明显改善,疗效满意。     

术中脑电图监测手术治疗难治性癫痫

目的:观察应用术中脑电图监测手术治疗顽固性癫痫的临床疗效,方法:9例患者术前以脑电生理、影像学资料和临床表现为依据初步定位,手术均为全麻,术中再进行脑电图监测,直视下进一步确认癫痫灶的部位和范围,根据不同的监测情况,选择.不同的术式:单纯癫痫灶切除术3例,前颞叶切除+多软脑膜下横切术4例,单纯前颞叶切除术1例,一侧大脑半球切除术1例。癫痫灶切除后再进行脑电图检测,反复数次直至脑电图显示痫样放电全部或大部消失,背景明显好转为止。结果:9例术后病理检查为:胶质增生或变性6例,微血管畸形1例,纤维组织增生或疤痕形成2例。本组随访1～2年,手术后治疗结果按谭启福等提出的愈后标准分级,总有效率88.9％,满意率33.3％。结论:在术中脑电图定位系统的监测下,准确的定位癫痫灶,采用不同的术式切除是手术治疗难治性癫痫的有效途径。     

以癫痫发作为临床表现的神经梅毒患者的临床特征

目的探讨以癫痫发作为表现的神经梅毒患者的临床特征。 方法回顾分析2014年8月至2019年5月就诊于首都医科大学附属北京地坛医院神经内科表现为癫痫发作的21例神经梅毒患者的临床特点及脑电图、影像学资料。 结果入组患者男性占数量优势（20例）;14例为局灶起源的发作（其中9例由局灶扩散至双侧强直-阵挛发作）,4例为未知起源的强直-阵挛发作,1例为未知起源的惊厥性癫痫持续状态,2例仅于脑电图见到痫性波而无临床发作。14例患者为麻痹型痴呆,其余为脑膜脑炎型（4例）、脑膜血管型（2例）及树胶肿型（1例）。患者癫痫发作间期脑电图表现为慢波节律、癫痫波、蝶骨电极位相倒置或正常。共随访16例患者,其中10例无癫痫发作。 结论以癫痫发作及精神症状为表现的患者,需要考虑神经梅毒,早期发现及积极驱梅治疗可改善预后。     

基于立体脑电图技术治疗难治性颞叶癫痫的研究进展

颞叶癫痫在所有局灶性癫痫中发病率最高, 具有病因学、症状学及电生理特征多样, 进展为难治性癫痫率高的特点。手术是治疗难治性颞叶癫痫的有效手段, 但传统方法通常难以对致痫区进行准确定位, 立体脑电图技术为致痫区的准确定位提供了有效手段。基于立体脑电图的射频热凝和MRI引导的激光间质热疗, 为手术风险高、难度大的难治性癫痫患者的外科治疗提供了精准、微创的新选择。     

术中磁共振导航辅助显微外科手术治疗颞叶内侧型癫痫

目的 探讨术中磁共振影像神经导航系统在辅助显微外科手术治疗颞叶内侧型癫痫的应用价值. 方法 对26例诊断明确的难治性颞叶内侧型癫痫患者,采用术中磁共振影像实时神经导航辅助,结合术中脑电图监测,行显微外科手术切除前内侧颞叶、海马及杏仁核. 结果 26例患者术后复查核磁均显示前内侧颞叶切除满意,病理证实内侧结构萎缩或硬化;本组患者随访12个月以上,癫痫发作完全消失者(Engel Ⅰ级)23例(88.5％),癫痫发作极少者(EngelⅡ级)2例(7.7％),癫痫发作有手术价值的减少者(EngelⅢ级)1例(3.8％).患者均未出现严重的手术并发症,神经功能保持良好. 结论 术中磁共振导航辅助显微外科手术治疗颞叶内侧型癫痫,既能彻底切除致痫灶,又能有效地保留神经功能,提高了手术的准确性与安全性.     

难治性颞叶癫痫的显微外科治疗

目的 总结显微外科手术治疗难治性颞叶癫痫的临床经验。方法 回顾性分析显微外科手术切除前颞叶50例颞叶癫痫的病例。结果 无死亡病例。术后随访半年至5年，症状发作完全消失25例，基本消失13例，发作次数减少50％或变型小发作9例，无效3例，有效率达95％。结论 应用显微外科技术切除前颞叶治疗颞叶癫痫可以明显减少并发症，提高临床疗效。     

Surgical treatment for extratemporal epilepsy

Opinion statement Partial seizures of extratemporal origin may present unique challenges in the patient with medically refractory seizures. The efficacy of an extratemporal focal cortical resection may be less effective than an anterior temporal lobectomy for intractable epilepsy. The potential operative complications may be increased in individuals with extratemporal epilepsy because of functional cerebral cortex involvement and the need for a large cortical resection to significantly reduce seizure tendency. Partial seizures of extratemporal origin are predominantly associated with frontal lobe epilepsy. The most effective treatment for intractable partial epilepsy is a focal cortical resection with excision of the epileptogenic zone, that is, an area of ictal onset and initial seizure propagation. The preoperative evaluation and operative strategy in patients with partial epilepsy of extratemporal origin associated with pharmacoresistant seizures is determined by the anatomic localization of the epileptogenic zone and the presence of a substrate-directed disorder. The goals of surgical treatment in extratemporal epilepsy include rendering the patient seizure-free, avoiding operative morbidity, and allowing the individual to become a participating and productive member of society. Before surgical treatment, the individual with extratemporal epilepsy will require a comprehensive preoperative evaluation, including routine electroencephalogram (EEG), long-term EEG monitoring, neuropsychologic studies, and magnetic resonance imaging (MRI). Patients with a normal MRI study, conflicting preoperative evaluation, or involvement of suspected functional cerebral cortex would require chronic intracranial EEG monitoring. The rationale for intracranial EEG includes localization of the ictal onset zone or intraoperative functional mapping, or both. Two-fluorodeoxyglucose positron emission tomography studies are usually unremarkable in patients with extratemporal epilepsy and normal MRI scans. Subtraction ictal single photon emission computed tomography coregistered to MRI (SISCOM) study may be useful to demonstrate a localized cerebral perfusion alteration in patients with intractable partial epilepsy. The diagnostic yield of SISCOM has been confirmed in patients with extratemporal epilepsy undergoing surgical treatment. The results of the SISCOM study may tailor the placement of intracranial EEG electrodes and affect the operative strategy. Patients with extratemporal epilepsy overall are less favorable operative candidates than individuals with medial temporal lobe epilepsy. However, individuals with MRI-identified lesional pathology of SISCOM-identified perfusion alterations concordant with the epileptogenic zone may be considered for surgical treatment. Chronic intracranial EEG monitoring may be necessary to confirm the localization of the ictal onset zone before epilepsy surgery. Patients with normal neuroimaging studies and extratemporal epilepsy are unlikely to be rendered seizurefree with focal cortical resection and should be considered candidates for other alternative forms of treatment for intractable partial epilepsy. Patients with non-substrate-directed extratemporal epilepsy should undergo a preoperative evaluation and surgical treatment at a comprehensive epilepsy center with extensive experience in chronic intracranial EEG monitoring and contemporary neuroimaging procedures because of the inherently high acuity associated with the operative management clinical disorder.     

脑室腹腔分流术治疗脑积水38例分析

目的 总结脑室腹腔分流术在治疗脑积水过程中的手术技巧和并发症的防治,以提高手术疗效.方法 对38例脑积水患者行脑室腹腔分流术治疗.结果 38例患者经过随访（平均6个月）.术后症状明显改善26例,好转9例,症状无明显改善3例.8例发生术后并发症,其中术后感染2例,分流管阻塞l例,分流不足3例,硬膜下积液1例,癫痫1例.结论 正确选择分流装置的置放路径,采用规范的手术操作和严格的无菌技术可有效降低脑室腹腔分流术后并发症的发生,提高临床疗效.     

Which is the Most Appropriate Disconnection Surgery for Refractory Epilepsy in Childhood?

Children with unilobar or multilobar pathology issuing in refractory epilepsy are potential candidates for surgical treatment. Extensive surgery results in good seizure control, but it also increases the risk of neurological deficits as well as motor and mental problems. We reviewed the cases of 19 children with refractory epilepsy treated surgically at Osaka University Hospital. Four of the 19 patients underwent temporal disconnection, 2 underwent occipital lobectomy, 4 underwent temporoparietooccipital disconnection, 6 underwent functional hemispherotomy, and 3 underwent corpus callosotomy. A good surgical outcome, i.e., Engel’s class I or II, was achieved in 12 (63%) of the 19 patients. Excellent surgical outcomes and satisfactory motor and mental development were achieved in 4 patients who underwent temporoparietooccipital disconnection. The outcomes of functional hemispherectomy were also satisfactory. The outcomes of temporal disconnection and corpus callosotomy were poor in comparison to outcomes of the other procedures. We believe that better surgical outcomes would have been achieved with temporoparietooccipital disconnection in some cases treated by temporal disconnection or occipital resection. Adequate extensive surgical procedures should be considered for refractory childhood epilepsy arising from unilobar or multilobar pathology.     

脑室腹腔分流术治疗脑积水83例临床分析

目的探讨脑室腹腔分流术治疗脑积水的手术技巧和并发症的防治,以提高手术疗效。方法回顾性分析83例脑积水患者的临床资料,均行脑室腹腔分流术治疗。结果 83例均获随访,平均18月(9月~6年)。术后症状明显改善57例,好转21例,症状无明显改善5例。11例发生术后并发症,其中分流管阻塞4例,术后感染3例,硬膜下血肿1例,硬膜下积液1例,裂隙脑室1例,癫痫1例。结论正确选择分流装置的置放路径,采用规范的手术操作和严格的无菌技术可有效降低脑室腹腔分流术后并发症的发生,提高临床疗效。     

Vagus nerve stimulation for the treatment of refractory epilepsy

Proposed as an additive symptomatic treatment of refractory epilepsy, vagus nerve stimulation (VNS) has proven to be effective and well-tolerated in patients presenting with refractory epilepsy for whom cortical resection is not indicated. After two years of treatment, the overall reduction of seizure frequency averaged 40%. In 50% of the patients, the frequency of seizures decreased by at least 50%. Moreover, even in absence of a significant reduction of seizures, patients who undergo this treatment reported an improvement in their quality of life. Economic surveys also demonstrate a favorable impact of VNS on the management of refractory epilepsy. Since 1988, 65,000 patients with refractory epilepsy throughout the world have been treated by VNS for this indication (1000 in France). The surgical implantation technique used in our department, the effects of vagus nerve stimulation reported in the literature, and our experience with a cohort of 70 patients with refractory epilepsy who received implants over the last 10 years are described.     

难治性癫痫外科治疗现状

癫痫是许多发展中国家较常见的神经系统疾病,其中约20％～25％患者经抗癫痫药物治疗无效而需手术治疗。事实表明,精确的致痫灶定位可以提高手术的成功率,早期有效的外科治疗不仅使患者癫痫发作消失或频率减少,且能显著改善患者生活质量。本文就难治性癫痫的术前评估及外科治疗方法做一综述。     

A surgical revisitation of Pott distemper of the spine.

BACKGROUND CONTEXT: Pott disease and tuberculosis have been with humans for countless millennia. Before the mid-twentieth century, the treatment of tuberculous spondylitis was primarily supportive and typically resulted in dismal neurological, functional and cosmetic outcomes. The contemporary development of effective antituberculous medications, imaging modalities, anesthesia, operative techniques and spinal instrumentation resulted in quantum improvements in the diagnosis, management and outcome of spinal tuberculosis. With the successful treatment of tuberculosis worldwide, interest in Pott disease has faded from the surgical forefront over the last 20 years. With the recent unchecked global pandemic of human immunodeficiency virus, the number of tuberculosis and secondary spondylitis cases is again increasing at an alarming rate. A surgical revisitation of Pott disease is thus essential to prepare spinal surgeons for this impending resurgence of tuberculosis. PURPOSE: To revisit the numerous treatment modalities for Pott disease and their outcomes. From this information, a critical reappraisal of surgical nuances with regard to decision making, timing, operative approach, graft types and the use of instrumentation were conducted. STUDY DESIGN: A concise review of the diagnosis, management and surgical treatment of Pott disease. METHODS: A broad review of the literature was conducted with a particular focus on the different surgical treatment modalities for Pott disease and their outcomes regarding neurological deficit, kyphosis and spinal stability. RESULTS: Whereas a variety of management schemes have been used for the debridement and reconstruction of tuberculous spondylitis, there has also been a spectrum of outcomes regarding neurological function and deformity. Medical treatment alone remains the cornerstone of therapy for the majority of Pott disease cases. Surgical intervention should be limited primarily to cases of severe or progressive deformity and/or neurological deficit. Based on the available evidence, radical ventral debridement and grafting appears to provide reproducibly good long-term neurological outcomes. Furthermore, recurrence of infection is lowest with such techniques. Posterior operative techniques are most effective in the reduction and prevention of spinal deformity. CONCLUSIONS: Unlike historical times, effective medical and surgical management of tuberculous spondyitis is now possible. Proper selection of drug therapy and operative modalities, however, is needed to optimize functional outcomes for each individual case of Pott disease.     

交锁髓内钉与锁定钢板治疗肱骨近端骨折的疗效研究

目的 探讨交锁髓内钉与锁定钢板治疗肱骨近端骨折的近期疗效.方法 对2003年1月至2008年6月应用交锁髓内钉与锁定钢板治疗的36例肱骨近端骨折患者进行回顾性研究,男11例,女25例;年龄26～78岁,平均60.3岁.根据治疗方法不同分为交锁髓内钉组(21例)与锁定钢板组(15例).按Neer分型:交锁髓内钉组:Ⅱ型6...     

Surgery for focal cortical dysplasia.

Interest in surgery for focal cortical dysplasia has grown with the enhanced ability to detect these lesions preoperatively with modern imaging techniques. This article focuses on the surgical management of epilepsy associated with focal cortical dysplasia. The authors highlight the approaches practiced at Yale University, review their recent series of operative cases, and discuss a representative case example to illustrate important aspects of surgical strategy.     

融合功能磁共振的神经导航结合皮层电极扫描在功能区难治性癫痫手术中的应用

目的探讨融合功能磁共振的神经导航结合皮层电极扫描在功能区难治性癫痫手术中的疗效。方法对11例难治性癫痫患者,于手术前分别进行运动、感觉、语言及视觉的磁共振脑功能成像扫描,将信息输入导航数据库,神经导航指引手术入路,术中配合皮层电极扫描切除病灶,尽可能减少功能区的损伤。结果1例于术后第1d出现癫痫发作。术后2周、1月和3月随访,10例患者未见发作,1例于术后1月、3月时各发作1次。术后病理：脑皮层发育不良5例 海绵状血管瘤2例 灰质异位症2例 钙化灶1例 少突胶质星形细胞瘤1例。随访4～7个月,11例均无明显功能障碍。结论功能磁共振神经导航联合皮层电极扫描辅助治疗功能区难治性癫痫手术定位准确,损伤小,疗效明显。