多处软脑膜下横纤维切断术治疗难治性癫痫的应用研究

目的 总结多处软脑膜下横纤维切断术(multiple subpial transection,MST)与其他术式联合应用治疗难治性癫痫的疗效。方法 195例难治性癫痫患者,部分性发作者81例,全面性发作者114例。根据手术前脑电图、SPECT、PET、CT及MR定位检查,结合术中皮层电极脑电图探测结果,划出致痫灶地域图,于显微镜下先行致痫灶及颞叶基底部切除或胼胝体切开;而后对周围或广泛性棘波发放区施行多处软脑膜下横纤维切断,最后经皮层电极脑电图探查显示病变区癫痫样波形完全消失即完成手术。结果 195例患者,行大脑半球广泛单纯性MST者39例(20.00％);大脑半球表面蛛网膜粘连带切除减压+MST者21例(10.78％);颞尖部及颞叶基底部切除+颞叶新皮质MST者39例(20.00％);大脑半球局限性病变及致痫带切除+广泛性MST者50例(25.64％);病灶周边局限性MST者16例(8.21％);胼胝体前2/3切开+双额叶前部MST者30例(15.38％)。无一例发生手术死亡,亦未出现严重并发症。随访80例患者,优45例(56.25％),良20例(25.00％),中9例(11.25％),差6例(7.50％);有效率为92.50％,显效率为81.25％。结论 联合应用MST与致痫灶切除、颞叶内基底区切除或胼胝体切开是治疗难治性癫痫患者的有效方法,值得推广应用。

Combined operations with MST in the treatment of intractable epilepsy

[Abstract] Objective To summarize the therapeutic effect of multiple subpial transection (MST) combined with other operations in the treatment of intractable epilepsy. Methods A total of 195 patients with intractable epilepsy (81 cases with partial seizure and 114 cases with generalized seizure) were enrolled in this study. According to the preoperative EEC, single photon emission computed tomography (SPECT), positron e-mission tomography (PET), CT and MR locating measures combined with electrocorticography (ECoG) detection during operation, the epileptogenic focus was defined. The epileptogenic focus and basal part of temporal lobe were resected (or the corpus callosum was incised), then the multiple subpial transection was performed in the peripheral and spike waves widespread region with operative microscope. The operation would be terminated when the epileptic waves in lesion area were completely disappeared during monitoring with ECoG. Results In 195 cases the operations were performed as follows: extensive simple MST in cerebral hemisphere (n=39), removal of arachnoid adhesion band in cerebral hemisphere and decompression + MST (n=21), resection of temporal apex and basal part + temporal cortex MST (n=39), resection of local lesion and epileptogenic band in cerebral hemisphere + extensive MST (n=50), peri-focal local MST (n=16) and resection of anterior 2/3 of corpus callosum + bilateral anterior frontal lobe MST (n=30). Postoperative death or severe complications were not found. The outcomes of 80 patients in the following up 2-8 years were defined as excellent 45 cases (56.25%), good 20 cases (25.00%), moderate 9 cases (11.25%) and poor 6 cases (7.50%), the effective rate was 92.50% and significant effective rate was 81.25%. Conclusion The results indicate that MST combined with epileptogenic focus resection, selective resection of temporal basal part or incision of corpus callosum is an effective and safe approach of the surgical treatment for intractable epilepsy.