病灶切除与热灼联合术治疗顽固性癫痫

目的　观察病灶切除辅以皮质痫灶横纤维热灼术治疗顽固性癫痫的临床效果。方法　病灶切除辅以皮质痫灶热灼组的病人和单纯病灶切除组病人的疗效进行分析比较。结果　病灶切除辅以皮质痫灶热灼组效果优于单纯病灶切除组 ,两者的临床效果存在极显著性差异 (P <0 .0 1) ;同时 ,病灶切除辅以皮质痫灶热灼组无永久性的术后并发症。结论　病灶切除辅以皮质痫灶热灼术是治疗顽固性癫痫安全有效的方法 ,长期疗效有待于进一步观察     

病灶切除辅助周围癎灶皮质横纤维热灼治疗继发性癫癎

目的 观察病灶切除加周围癎灶皮质横纤维热灼治疗继发性癫癎的临床效果。方法 对71例病灶切除加热灼的病人和78例单纯病灶切除病人的疗效进行对比分析。结果 病灶切除辅助热灼组效果优于单纯病灶切除组，两存在显性差异。病灶切除加热灼无术后并发症。结论 病灶切除辅助周围癎灶皮质热灼是治疗继发性癫癎安全有效的方法，长期疗效有待于进一步观察。     

病灶切除辅助周围 灶皮质横纤维热灼治疗继发性癫

目的观察病灶切除加周围灶皮质横纤维热灼治疗继发性癫的临床效果。方法对71例病灶切除加热灼的病人和78例单纯病灶切除病人的疗效进行对比分析。结果病灶切除辅助热灼组效果优于单纯病灶切除组,两者存在显著性差异。病灶切除加热灼无术后并发症。结论病灶切除辅助周围灶皮质热灼是治疗继发性癫安全有效的方法,长期疗效有待于进一步观察。     

手术方法治疗顽固性癫癎

目的对顽固性癫癎病人联合采用几种手术方法,对其临床疗效进行评价,以探讨不同类型顽固性癫癎的最佳治疗方案.方法手术治疗顽固性癫癎51例.术前均行头皮脑电视频连续监测,及MRI、SPECT检查.行单纯局部致癫癎病灶切除术7例,加行皮质软膜下横纤维切断术3例,加行皮质热灼术12例,加行皮质热灼术及胼胝体切开术5例;前颞叶切除术+皮质热灼术17例,立体定向核团毁损术6例,迷走神经刺激术1例.结果无手术死亡及术后并发症,随访3～24个月,手术总有效率90.2%,优良率70.6%.结论多种手术联合治疗顽固性癫癎病人安全、有效.     

双极电凝热灼联合病灶切除治疗涉及功能区癫癎的疗效观察

目的观察双极电凝热灼功能区致灶联合非功能区致灶切除治疗涉及功能区癫癎病人的疗效。方法回顾性分析40例致灶涉及功能区的癫癎病人的临床资料,行功能区致癎皮质电凝热灼及非功能区致癎灶切除。结果术后随访18-48个月,平均25个月。5例病人术后对侧有轻度的偏瘫,2例病人术后有轻度的感觉性失语,所有并发症均在1年内恢复。术后观察疗效：EngelⅠ级18例（45%）,EngelⅡ级8例（20%）,EngelⅢ级8例（20%）,EngelⅣ级6例（15%）。结论脑皮质电凝热灼术是治疗功能区癫癎有效且安全的方法,通过病灶切除联合脑皮质电凝热灼术治疗涉及功能区的癫癎,可取得良好的疗效。     

顽固性癫的神经病理学改变

目的 :探讨顽固性癫的神经病理学改变。方法 :对 3 5例顽固性癫病人采用皮质脑电图描记下致灶切除 ,切除的组织送病理检查。结果 :术后病理报告 :肿瘤 10例 ;血管畸形 5例 ;颅内囊肿 6例 ;炎性肉芽肿 3例 ;外伤性软化灶 3例。余 8例为神经元变性 ,胶质细胞增生 ,含铁黄色素沉积 ,淋巴细胞侵润等。结论 :顽固性癫的致灶组织均存在着病理改变 ,且病理改变与临床效果密切相关。     

病灶切除辅助周围痫灶皮质横纤维热灼治疗继发性癫痫

目的：观察病灶切除辅助周围痫灶皮质横纤维热灼治疗继发性癫痫的临床效果。方法：比较71例病灶切除加热灼的患和78例单纯病灶切除患的疗效。结果：病灶切除辅助热灼组效果优于单纯病灶切除组，两存在显差异（P＜0．05）。病灶切除加热灼治疗无术后并发症。结论：病灶切除辅助周围病灶皮质热灼是治疗继发性癫痫的安全有效的方法。     

神经导航引导海马病灶切除联合皮质热灼治疗顽固性颞叶内侧癫痫

目的探讨神经导航引导、皮质电极监测下对海马病灶进行致痫灶切除,辅助以皮质痫灶横纤维热灼术治疗顽固性颞叶内侧癫痫的临床价值。方法通过对16例海马病灶的顽固性癫痫的病人,术前进行24小时脑电图描记定位致痫灶,手术前进行磁共振扫描,数据输人神经导航系统,手术当天进行导航注册配准．术中进行颞叶皮质电极描记,并在导航棒引导下找寻海马病灶,完整切除并辅以皮质热灼治疗致痫灶。结果术后0．5～3年内随访,按Engel癫痫疗效分级：发作完全消失11例(68．8％),明显改善4例(25％),改善1例(6．2％)。结论神经导航有助于海马病灶的准确找寻与切除,在皮质电极监测下,辅助皮质热灼是治疗顽固性颞叶内侧癫痫的一种有效、安全的方法。     

联合应用皮质(癎)灶热灼术治疗继发性癫(癎)

目的分析总结继发性药物难治性癫癎的临床特点,讨论如何改进手术方法．将几种手术结合使用并对手术效果进行评价。方法回顾性分析4年来经显微手术治疗的16例继发性药物难治性癫癎病例．这16例术前均行VEEG监测及MRI检查,其中5例行头PET检查。手术在皮层脑电监测下进行,2例行单纯病灶切除术．13例行病灶切除＋灶旁皮层热灼术,1例行病灶切除一灶旁皮层热灼术十胼胝体切开术。结果所有病人随访6个月至4年．术后抗癫癎药减少．12例服用1种抗癫癎药,2例服用2种抗癫藕药。癫癎发作完全控制11例．显著改善3例。无变化2例．无明显并发症．无死亡。结论病灶切除＋灶旁皮层热灼术联合应用不但提高了控制癎性发作的疗效．还尽可能多地保护神经组织免遭切除或损害,这是治疗继发性药物难治性癫癎较合理和有效的方法。     

MRI阴性难治性儿童额叶癫的脑电图特点及外科治疗(附25例分析)

目的总结分析MRI阴性难治性儿童额叶癫的脑电图特点及手术治疗方法和预后。方法回顾性分析25例MRI阴性难治性儿童额叶癫病例的治疗经验。根据病儿发作的症状及头皮脑电图特点,在可疑的癫灶起源区植入颅内电极,行皮质脑电图(ECoG)监测,根据其间期、发作期特点制定癫灶切除计划。病灶位于功能区时术中行皮质电刺激,进行癫灶及功能区定位。结果本组行单纯前额叶切除7例,前额叶切除加局限性皮质切除4例,局限性皮质切除加皮质热灼6例,前额叶外侧切除加局限性皮质切除3例,前额叶内侧切除加局限性皮质切除5例(其中3例加胼胝体切开);对其中6例灶位于功能区病人于局限性皮质切除后加行皮质热灼。无手术死亡及严重并发症发生,随访12～24个月,手术后疗效按Wilson标准评判,癫发作完全消失7例,发作次数显著减少8例,发作程度减轻6例,无明显改善4例;优良率为84%。结论分析头皮脑电图初步定位癫灶后,再应用颅内电极进行精确致灶及功能区定位,制定个体化治疗计划,选择前额叶切除、局限性皮质切除、皮质热灼、胼胝体切开或根据需要联合多种术式,是治疗MRI阴性难治性儿童额叶癫的有效方法。     

病灶切除与热灼联合术在难治性癫痫治疗中的应用

目的 研究病灶切除与热灼联合手术方法治疗继发性、难治性癫痫的临床效果。方法 对291例继发性、难治性癫痫患采取病灶切除与热灼联合手术的治疗方法，并随访观察此种联合手术方法对难治性癫痫的控制效果：结果 采用病灶切除与热灼联合手术后，291例患中，有211例(72．5％)发作消失，有50例(17．2％)发作减少50％以上，对癫痫总的有效控制率为89．7％，随访1．5～4．0年，平均23个月，211例发作消失的患中有83例(39．3％)已停服抗癫痫药；同时，病灶切除与热灼联合术无永久性的术后并发症：结论 病灶切除与热灼联合术治疗继发性、难治性癫痫，安全并且治疗效果令人满意。     

幕上脑海绵状血管瘤并癫痫的手术策略(附57例临床分析)

目的探讨伴有癫痫病史的幕上脑海绵状血管瘤(CA)的手术策略。方法回顾性分析57例伴有癫痫病史的幕上脑海绵状血管瘤患者的资料,依据癫痫发作情况将其分为顽固组(41例)和偶发(或初发)组(16例)。顽固组内行单纯病变切除者15例,行病变切除及致痫灶扩展切除者26例。分别分析其病灶部位、临床表现、切除范围与术后随访结果。结果57例患者均行显微手术治疗,40例部位深在,均运用导航指引术中定位。本组无远期神经功能障碍,术后癫痫控制EngleⅠ级45例(81.8%),EngleⅡ级4例(7.3%),EngleⅢ级4例(7.3%),EngleⅣ级2例(3.6%)。结论①幕上脑海绵状血管瘤伴发癫痫的患者应尽早行手术治疗。②对于初发或偶发癫痫患者,手术切除病变及周围含铁血黄素沉积带即可获得满意的癫痫控制;对于顽固性癫痫患者,在前者基础上加行致痫皮层切除或脑叶切除将获得更理想的效果。③脑磁图检查结合EEG对术前癫痫灶定位有较大帮助。     

Intraoperative electrocorticography‐guided microsurgical management for patients with onset of supratentorial neoplasms manifesting as epilepsy: a review of 65 cases

Aim. We reviewed the surgical procedures guided by intraoperative electrocorticography and outcome of 65 patients with onset of supratentorial neoplasms manifesting as epilepsy. Method. Clinical data were obtained for 65 patients with supratentorial neoplasms who received surgery, with the aid of intraoperative electrocorticography to screen epileptogenic foci before and after removal of neoplasms, and depth electrodes when needed. According to electrocorticography findings, appropriate surgical procedures were performed to treat the epileptogenic foci. In the control group, 72 patients received simple lesionectomy. Postoperative seizure outcomes were documented and analysed retrospectively. Results. In the case group, 33 patients received lesionectomy only, while the other 32 patients underwent intraoperative electrocorticography‐guided tailored epilepsy surgery. In total, 57 patients (87.7%) in the case group and 38 patients (52.8%) in the control group were seizure‐free (Engel Class I). Comparing outcomes of patients with temporal lesions between the two groups, 80.0% patients (12/15) in the case group and 20.0% (3/15) in the control group were seizure‐free. Furthermore, comparing the seizure outcomes of patients who finally underwent tailored epilepsy surgery and simple lesionectomy (33 after electrocorticography and 72 without electrocorticography), intraoperative electrocorticography‐guided tailored epilepsy surgery demonstrated superiority over lesionectomy (Engel Class I; 87.5% vs. 63.8%, respectively). Conclusions. Electrocorticography plays an important role in the localisation of epileptogenic foci and evaluation of the effects of microsurgical procedures intraoperatively. Isolated lesionectomy is not usually sufficient for better postoperative seizure outcome. In addition, for patients with temporal tumours, especially in the non‐dominant hemisphere, a more aggressive strategy, such as an anterior temporal lobectomy, is recommended.     

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.     

Epilepsy with temporal encephalocele: Characteristics of electrocorticography and surgical outcome

Temporal lobe encephaloceles (TEs) are increasingly identified in patients with epilepsy due to advances in neuroimaging. Select patients become seizure‐free with lesionectomy. In practice, however, many of these patients will undergo standard anterior temporal lobectomy. Herein we report on the first series of patients with refractory temporal lobe epilepsy (TLE) with encephalocele to undergo chronic or intraoperative electrocorticography (ECoG) in order to characterize the putative epileptogenic nature of these lesions and help guide surgical planning. This retrospective study includes nine adult patients with magnetic resonance imaging/computed tomography (MRI/CT)–defined temporal encephalocele treated between 2007 and 2014 at University of California San Francisco (UCSF). Clinical features, ECoG, imaging, and surgical outcomes are reviewed. Six patients underwent resective epilepsy surgery. Each case demonstrated abnormal epileptiform discharges around the cortical area of the encephalocele. Two underwent tailored lesionectomy and four underwent lesionectomy plus anterior medial temporal resection. Postoperatively, five patients, including both with lesionectomy only, had Engel class Ia surgical outcome, and one had a class IIb surgical outcome. The role of TE in the pathogenesis of epilepsy is uncertain. ECoG can confirm the presence of interictal epileptiform discharges and seizures arising from these lesions. Patients overall had a very good surgical prognosis, even with selective surgical approaches.     

A comparative study of lesionectomy versus corticectomy in patients with temporal lobe lesional epilepsy

We performed a retrospective study comparing surgical outcome of anterior temporal lobectomy (n = 20) and stereotactic lesionectomy (n = 14) in 34 consecutive patients with intractable partial epilepsy evaluated at this institution between June 1986 and June 1992. All patients had medically refractory partial seizures and a neuroimaging-identified temporal lobe foreign-tissue lesion. Patients underwent a pre- and postoperative comprehensive evaluation. In all patients, postoperative neuroimaging studies indicated complete lesion resection. Seventy-one percent of lesionectomy patients and 90% of lobectomy patients, respectively, experienced a worthwhile reduction in seizure tendency. Forty-three percent of lesionectomy patients and 85% of lobectomy patients, respectively, were seizure-free postoperatively. Mean duration of follow-up was 51 months (range, 21–83 months). Morbidity occurred in three patients who underwent corticectomy: complete homonymous hemianopsia (1) and dysphasia (2). No significant morbidity was associated with lesionectomy. Results of this study have altered the surgical strategy at this institution for patients with temporal lobe lesional epilepsy and have proved useful in counseling patients regarding neurologic outcome.     

Prediction of postoperative outcome with special respect to removal of hemosiderin fringe: a study in patients with cavernous haemangiomas associated with symptomatic epilepsy.

PURPOSE: In this study 30 patients with symptomatic epilepsy caused by cavernomas were investigated in a postoperative follow up study to assess predictors for postoperative outcome with respect to indications, time and approach of surgery. METHODS: Thirty patients with cavernomas refractory to medical treatment were scheduled for surgery based on the findings of high-resolution MR imaging and intensive EEG-video monitoring. Postoperative outcome of epilepsy was assessed by follow-up examinations based on the basis of classification by Engel and the International League against epilepsy (ILAE). RESULTS: The following variables were associated with good postoperative outcome: (1) complete resection of hemosiderin fringe surrounding the cavernoma was correlated to less postoperative seizure frequency versus incomplete resection of the hemosiderin fringe according to the outcome protocol of ILAE. (2) Lower duration of epilepsy at the time of operation was correlated to a better postoperative outcome with a benefit for recovery. (3) Absence of hemorrhage before surgery and unifocal seizure onset was a predictor for a favorable outcome, whereas bilateral or multifocal seizure onset zones showed poorer postoperative outcomes. (4) In patients with dual pathology (hippocampal sclerosis in addition to a cavernoma), lesionectomy plus hippocampectomy as opposed to lesionectomy only, had a better outcome than single lesionectomy. CONCLUSION: Postoperative outcome in patients with cavernomas should be the topic of further prospective multicenter studies involving a large number of patients. In addition to the ideal operation time and handling of dual pathology the role of extended resection including perilesional hemorrhages should be taken into account.