皮质广泛性痫灶多软膜下横纤维切断手术方法的研究

目的：脑皮质的广泛性癫痫灶累及脑主要功能区，采用多软膜下横纤维切断术以阻断痫灶同步放电的扩散，达到消除临床发作。方法：共选择了８０例皮层广泛性癫痫灶位于脑主要功能区者，其中左侧大脑半球４５例，右侧２６例，双侧弥漫性痫灶９例，均采用半球凸面多脑回软膜下神经细胞树突（横）纤维切断，同时保护轴突垂直柱不受损伤的方法，每次横切间距５ｍｍ，深４ｍｍ。结果：无任何功能障碍或其它严重并发症，无手术死亡者，术后随访６～５６个月者６０例，其中优３６例，良１１例，发作消失５０％或改型９例，无效（同术前）４例，总有效率９３％，显效率达７８％。结论：本文在讨论了癫痫的外科治疗及多软膜下横切术的机理及手术技术后，提出这一手术是治疗脑皮质主要功能区癫痫的有效方法。

The study of multiple subpial transection to the cortex expending focus

Objective: For the cortex expendiing focus we use multiple subpial tranaection(MST)to block the spreading of focus syncronized discharge,so as to eliminate the clinical attack. Method: 80 cases of epilepsy whose epileptogenic focus were expending in cortex and involve thd functional area were studied. The focus were located in left hemisphere in 45 cases, right in 26, and bilateral hemisphere in 9. We use MST in all cases to cut break the neuron's dendritic (transvers) fiber of cortex multigyrus while preserving the vertical column. The distance between two transections was 5mm, and the depth of transection was 4mm. Result: No functional deficit on severe complication occurred. There is no operative death postoperatively. 60 cases were followed up for 6 56 months. The outcome was excelent in 36 cases, good in 11,seizure reduce in 50% or change the type in 9,and no change (as the same of preoperation)in 4. The total effective rate was 93%.Significant effective rate was 78%. Conclusion: After the dicussion of the surgical treatment of epilepsy and the machanism and surgical tecnique of MST, we point out that this approach is an effective method to terat the functional cortex epilepsy.