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。

Surgical management of pediatric intractable epilepsy

Objective To investigate the surgical management of pediatric intractable epilepsy. Methods The surgical experience of 142 pediatric patients with intractable epileptic between 2（102 and 2007 was reviewed. Resection of epileptogenic foci or labe, and （or） multiple subpial transaction （MST） was carried out when a focal epileptic discharge was indicated according to preoperative evaluation and electroc：onieography （EcoG）, but multilobar resection with MST and （or） corpus callosotomy was chosen to deal with hemispheric multiple epileptic foci. Results During the follow-up, 3 years in average, 65 of 142 patients had post-operative outcome of Engel Class Ⅰ, 34 patients had rare seizure （Engel Class Ⅱ）, and 25 patients got a decrease in seizure frequency （Engel Class Ⅲ）. Mean full intelligence quotient （FIQ） improved from 65.4 to 80. 9, and more IQ improvement in patients with shorter seizure history and drug-resistance time. Temporary complications were observed in 16 patients and there was no death case. Conclusion Good surgical results can be achieved in pediatric patient with intractable epilepsy. Early surgical intervention in intractable pediatric epilepsy provides the good opportunity to control the seizure and prevent the irreversible worse of intelligence and the disability for a life-time.