蛛网膜囊肿伴癫痫的外科治疗

目的 探讨颅内网膜囊肿（arachnoid cyst,AC)与癫痫的关系以及外科治疗方法。方法 手术治疗23例颅内大脑凸面蛛网膜囊肿（AC）伴癫痫病人,采用AC和致痫灶切除21例,AC－腹腔分流术1例,胼胝体切开术1例。结果 23例病人中,完全不发作有5例,显改善有11例,无变化7例。结论 颅内AC可引起癫痫,采用AC和致痫灶切除效果较为理想。     

侧脑室内引流术治疗透明隔囊肿9例报告

侧脑室内引流术治疗透明隔囊肿９例报告陈援朝吕福林段作峰郑鲁谭林琼我们最近采用侧脑室内引流术治疗透明隔囊肿９例，现报告如下。临床资料男４例，女５例，年龄１６～４２岁，平均２８岁；病程７天～４年，平均６个月。临床表现不同程度头痛、头胀、呕吐、伴视物模糊３...     

应用神经内窥镜治疗脑室内囊肿

随着科学技术的发展,神经内窥镜手术的应用范围不断扩大。作为外科手术的一项新技术,神经内窥镜技术已应用到从诊断到治疗的神经外科许多领域。最近我院神经外科配置了美国Clams公司生产的神经内窥镜治疗系统,其中包括脑室镜、观察镜、治疗镜及与之配套的显微手术器械,我们     

侧脑室穿刺引流治疗1例透明隔囊肿

1 病例报告 病人,女性,32岁。因进行性头痛1年,不能行走1个月,于1996—12—28住院。病人于1年前起无明显诱因出现头痛,伴有头晕,初时尚轻,可忍受,但日渐加重,为持续性额枕部胀痛。近1个月来头痛剧烈,伴有恶心、呕吐,不能下床活动,曾多次在某县医院治疗,静脉点滴甘露醇后头痛缓解,1996—12—25头颅磁共振成像(MRI)示透明隔囊肿(图1),乃收住我科。入院查体:神志清楚、检查合作,双瞳大小为3mm,对光反射灵敏,双眼底视乳头边界模糊不清,A:V=1:3,无其他脑神经损害体征。颈软,心肺及腹部检查未见异常,四肢肌张力检查正     

父子同患透明隔囊肿伴精神障碍

例1,男性,48岁,工人,患者23岁结婚,婚后生育2女1子,患者自1985年出现性格古怪,无端恐惧,自称有人迫害他,不吃他人的食物,很少出家门,每当外出时为防止别人的暗害,前胸及后背各捆绑一个盘子。曾在多家医院诊断为精神病,查体心、肺、肝、脾未发现异常;精神检查:意识清晰,存     

透明隔囊肿伴精神病性症状1例

1病例患者,男,20岁,高二学生。1年前无明显诱因出现发呆,少语,讲话、行走时神色胆怯、慌张,不久整日卧床不起,说街上的人都在嘲笑他,要害他。因不能坚持学习休学在家,精神症状继续加重,又说父母是假的,远在外地的姑父天天都在骂他,他的血液从头顶上流走了,邻居小孩在他睡觉时往他的嘴里吐口水等。近半年来出现跛行。检查见右侧面部及肢体轻度偏瘫,     

颞叶蛛网膜囊肿继发癫痫的外科治疗

目的：探讨颞叶蛛网膜囊肿继发癫痫的临床特点及手术治疗效果。方法所有患者均以癫痫发作起病,其中蛛网膜囊肿在左颞有12例,右颞有13例。应用皮层脑电监测对这些患者行手术治疗,术后随访1年以上观察手术的疗效。结果所有患者在切除蛛网膜囊肿后皮层脑电图监测均见颞叶皮层有异常放电,其中15例患者加行了前颞叶切除术（包括大部分海马及杏仁核）,另外10例加行皮层热灼术。术后随访发现囊肿消失18例,囊肿明显减小7例。癫痫发作随访发现Engel Ⅰ级13例,Ⅱ级9例,Ⅲ级2例,Ⅳ级1例,手术总有效率88％。结论对于颞叶蛛网膜囊肿继发癫痫的患者,在手术切除蛛网膜囊肿的同时,应在皮层脑电图监测将癫痫灶一并切除,且手术治疗的效果较理想。     

父子同患透明隔囊肿伴精神障碍

患者男性 ,2 1岁 ,蒙族 ,战士。于 1 998年 3月无明显诱因出现头痛、头晕、失眠 ,在外院诊断为神经衰弱 ,治疗效果不理想 ;1 999年 2月出现动作迟缓 ,失眠加重 ,有时连续数天不睡眠 ,并伴有紧张、恐惧 ,敏感多疑 ,不愿与人交往 ,生活懒散 ,难以坚持工作 ,1 999年 3月收住我院。入院体格检查及神经系统检查未见异常 ;精神检查 :意识清楚 ,表情呆板 ,动作减少迟缓 ,定向及智能尚可。脑电图检查未见异常 ,脑ＣＴ显示透明隔增宽 ,双侧脑室外移。诊断 :透明隔囊肿伴精神障碍。给予氯氮平 2 5ｍｇ ,2次 ｄ ,并逐渐增加至 50ｍｇ ,早晨和中午各 1…     

癫痫的外科治疗

现代的癫痫外科治疗是由英国神经外科医师ＶｉｃｔｏｒＨｏｒｓｌｅｙ开创的，他在１８８６年为３个部份性癫痫病人实施了手术，取得了成功，在世界上产生了很大的影响。以后的工作由Ｆｏｒｓｔｅｒ和Ｐｅｎｆｉｅｌｄ等继承下来，特别是Ｐｅｎ－ｆｉｅｌｄ对癫痫的外科治疗，有较长久的研究，具有丰富的经验，为现代癫痫的外科治疗奠定了坚实的基础。本文复习１９７５年以来癫痫手术治疗方法的演变及其效果、①一、癫痫外科治疗的病例数量及其疗效近１０年来，癫痫外科治疗的病人数处于稳步增长状态，世界各地有许多著名的医院都有神经外科…     

Cyst of the septum pellucidum presenting as hemiparesis

An 11-year-old boy with Down syndrome is presented who suffered progressive hemiparesis on the left side for a period of 5 years. Computed tomography demonstrated a large cyst of the septum pellucidum and a calcified spot in the head of caudate nucleus on the right side. By penetrating the cyst wall to create a communication into the lateral ventricle, shrinkage of the cyst and improvement of the hemiparesis were obtained. The pathogenesis of the hemiparesis was presumed to be attributed to circulatory compromise in the deep cerebral veins, secondary to the cyst.     

透明隔囊肿

透明隔囊肿分为症状性与非症状性两种，前又称为扩张性透明隔囊肿，它可造成室问孔的梗阻，产生头痛、呕吐、视乳头水肿及意识障碍等颅压增高症状。当透明隔囊肿累及下丘脑一隔三角区或影响脑深部的静脉回流时，可出现行为、自主神经以及感觉运动功能的异常。一旦发生脑积水，可压迫视神经通路，引起神经眼科方面的症状。根据MRI所见和临床表现特点可确定诊断。应用脑的内窥镜技术，施行透明隔囊肿-脑室造屡或分流手术，可解除梗阻性脑积水，迅速缓解临床症状。     

Surgical Outcome in Patients with Epilepsy with Occult Vascular Malformations Treated with Lesionectomy

Summary: Purpose: This retrospective study reports the long-term surgical outcome of patients with medically refractory epilepsy and vascular malformations who were treated with lesionectomy. A detailed analysis of surgical failures had been performed in an attempt to define predictors of surgical success and failure.
Methods: Fifteen patients with medically intractable epilepsy and angiographically occult vascular malformations (AOVMs) were treated surgically with lesionectomy at Duke University Medical Center. Lesionectomy consisted of removal of the AOVM and surrounding hemosiderin-stained brain only, without the use of electrocorticography (ECoG) to guide resection.
Results: Eleven (73%) patients are seizure free after lesionectomy. Three showed no significant improvement, and one patient died, presumably after a seizure. Age of onset, duration of seizures, age at resection, and gender did not affect outcome. All patients with neocortical AOVMs in whom EEG findings correlated with the site of the lesion were seizure free after lesional resection. Treatment failures were associated with the presence of multiple intracranial lesions, poorly localized or diffuse EEG findings, discordant positron emission tomography (PET) imaging, or with a lesion in close proximity to the limbic system.
Conclusions: Lesionectomy, with removal of surrounding hemosiderin-stained brain, can be considered the procedure of choice in carefully selected patients with epilepsy with occult vascular malformations.     

经纵裂-透明隔间腔入路胼胝体切开术治疗难治性癫痫的手术方法及临床疗效

目的探讨经纵裂-透明隔间腔入路胼胝体切开术治疗药物难治性癫痫的手术方法和临床疗效。方法回顾性分析2014年1月至2019年1月上海交通大学医学院附属仁济医院功能神经外科收治的23例难治性癫痫患者的临床资料。患者均采用梯形小骨窗开颅,分别经纵裂-透明隔间腔入路行胼胝体前2/3切开术或一期胼胝体全节段切开术。术前行磁共振静脉成像(MRV)和图像三维重建辅助设计切口和骨窗。术后定期行影像学随访,采用Montreal神经研究所和医院Oguni等胼胝体切开术后疗效分级标准评估疗效。结果23例患者均顺利完成胼胝体切开手术,其中11例行胼胝体前2/3切开术,12例行一期胼胝体全节段切开术。23例患者中,22例沿中线切开胼胝体至透明隔腔,仅1例患者因脑发育畸形,术中探查透明隔腔缺失,改用经侧脑室入路切开胼胝体。患者术后均无颅内出血、脑积水和感染,无遗留长期神经功能障碍和并发症。MRI或弥散张量成像复查证实胼胝体切开范围达到要求。所有患者的中位随访时间为1.8年(0.5~5.2年)。术后疗效分级结果:A级4例、B级6例、C级6例、D级7例、E级0例,总有效率为69.6%(16/23)。结论经纵裂-透明隔间腔入路行胼胝体切开术可保持正中的手术路径,从而减少副损伤和并发症的发生,提高手术疗效。     

A Case of Infantile Meningioangiomatosis with a Separate Cyst

Meningioangiomatosis (MA) is a rare congenital tumor that occurs mostly in 5-15 year old children. There have been only 5 cases previously reported that described the cystic nature within these tumors. We present a case of a MA accompanied by a separate macrocyst. A normally developed 2 year-old female patient presented with partial and generalized seizures. The brain computerized tomogram and magnetic resonance imaging revealed the presence of a calcified mass accompanied by a cyst in the right parietal area, surrounded by low density and high attenuation edema and hemorrhage. Upon right parietal craniotomy, a 1.6 cm × 1.2 cm × 0.5 cm sized plate-like, gray-white, slightly hard mass was seen and it was completely excised. Approximately 1 cm from the mass in the anterior lateral direction, a cyst was found and subsequent biopsy of the cyst wall revealed no tumor tissue, and therefore the cyst was not removed. Pathologic report demonstrated the meningioangiomatosis. Follow up examination 2 years later showed no recurrence of the tumor, and there was no evidence of neurological deficits. Authors suggest that cysts that arise in the surrounding tissues of tumors may not be tumor cysts, and do not require surgical removal.     

Comparison between Initial and Recent Surgical Outcome of 15-Year Series of Surgically Remediable Epilepsy

Objective

The aim of this study is to compare the surgical outcome of the initial and recent surgical cases, during our 15-years experience, in terms of the surgical strategies and the prognostic factors for surgically remediable epilepsy.

Methods

We retrospectively reviewed and compared the surgical outcomes between the initial 256 (Group I) and recent 139 (Group II) patients according to the time period of operation for a total of 518 consecutive epilepsy surgeries at our institution since 1992. The patients of the middle intermediate period, which were subjected to changed surgical strategies, were excluded.

Results

The surgical outcome data from the initial and recent groups showed a much improved outcome for patients who underwent temporal lobe epilepsy (TLE) surgery over time. The number of patients with a good outcome (Engel class I-II) was much increased from 87.7% (178 TLE cases of Group I) to 94.8% (79 TLE cases of Group II) and this was statistically significant (p = 0.0324) on univariate analysis. Other remarkable changes were the decreased performance of intracranial invasive studies from 43.5% in Group I to 30.9% in Group II due to the advanced neuroimaging tools. The strip/grid ratio was reduced from 131/32 in Group I to 17/25 in Group II, because of a markedly reduced mesial TLE surgery and an increased extratemporal epilepsy surgery.

Conclusion

Our results show that surgical outcome of epilepsy surgery has improved over time and it has shown to be efficient to control medically intractable epilepsy. Appropriate patient selection, comprehensive preoperative assessments and more extensive resection are associated with good postoperative outcomes.     

Surgery of Epilepsy: Methods

ABSTRACT— The various surgical methods used in the management of epilepsy are reviewed. Intracranial recording procedures such as epidural and subdural recording are presented as well as their main indications, advantages and inconveniences. Emphasis is placed on the techniques of intracranial recording used at the Montreal Neurological Institute, namely chronic cortical and depth recording, both based on stereotactic localization procedures using MRI and DSA.
The various resective procedures for the surgery of epilepsy are discussed, namely cortical resections in various locations such as frontal, central parietal, occipital and temporal areas. Special emphasis is placed on techniques of cortical resection in the dominant hemisphere, using local anaesthesia and topographic mapping.
The indications and techniques of such procedures as callosotomy, selective amygdalo-hippocampectomy, hemispherectomy, and stereotactic interventions are also presented.     

Surgical treatment of epilepsy with chronic cerebral granuloma caused by Schistosoma japonicum

PURPOSE: To study the surgical treatment of epilepsy with cerebral granuloma caused by Schistosoma japonicum. METHODS: Two hundred fifty cases of epilepsy caused by cerebral schistosomiasis from 1955 to 2004 were analyzed retrospectively. RESULTS: There were no deaths. Follow-up of 196 cases for 4-5 years after operation demonstrated that 180 cases (92%) were seizure-free or well-controlled. CONCLUSIONS: Surgical treatment should be considered when drug therapy fails to control epilepsy or the lesion shows mass effect. Intraoperative electrocorticography monitoring is helpful to define the extent of the resection of the lesion.