颅内蛛网膜囊肿伴发癫痫的手术治疗

目的 通过对37例颅内蛛网膜囊肿(intracranial arachnoid cyst,IAC)伴发癫痫患者手术治疗情况的回顾分析,以期对此类患者手术方法的选择提供依据.方法 25例患者归为囊肿手术组,方法有囊肿壁切除术、囊肿-腹腔分流术和囊肿造瘘术;12例患者归为癫痫手术组,行囊肿壁切除术同时,切除囊肿周围萎缩变性致痫脑组织,如果患者残存颞叶内侧及杏仁核、海马结构,也予以切除,如囊肿周围邻近功能区,则通过体感诱发电位确定中央沟后于功能区行多处软膜下横切术,必要时行脑皮质离断术和胼胝体切开术,12例均行术中皮层脑电图监测.结果 术后37例患者中6例囊肿消失,17例减小,14例无变化,两组相比无显著性差异;囊肿手术组2例无发作,8例改善,15例无效,手术总有效率40%;癫痫手术组7例无发作,3例改善,2例无效,手术总有效率83.3%,两组相比有显著性差异(P＜0.05).结论 IAC伴发癫痫患者术前进行癫痫灶的确认,术中行囊肿壁切除术同时切除癫痫灶,大大提高IAC伴发癫痫的手术疗效.

Surgical treatment of intracranial arachnoid cyst with epilepsy

Objective To study the surgical treatment of intracranial arachnoid cyst with epilepsy by reviewing 37 patients.Methods The cyst-group included 25 patients who were treated by resection of the arachnoid cyst or cysto-peritoneal shunt or cystostomy,The another 12 patients were named epilepsy-group,who were treated not only by resection of the arachnoid cyst,but also by resection of the epileptiform tissues around the arachnoid cyst,or amygdala and hippocampus and mesial temporal lobe.If epileptogenic zone located in eloquent areas,so proformed multiple subpial transection after locating central sulcus by somatosensory evoked potential.Focal cortex disconnection or corpuscallosotomy was performed if it was necessary.All 12 patients were monitored by electrocorticogram in operation.Results In the 37 patients,intracranial arachnoid cysts were disappeared in 6 patients and deflated in 17 patients and unchanged in 14 patients after operation.There is no significant difference in two groups.In 25 patients of cyst-group,2 patients got sizure free and 8 patients got sizure reduced and 15 patients remained unchanged.On the other hand,In 12 patients of epilepsy-group,7 patients got sizure free and 3 patients got sizure reduced and 2 patients remained unchanged.There is a significant difference in two groups(P<0.05).Conclusion With locating epileptogenic zone preoperation and resection it after the resection of intracranial arachnoid cyst in operation,the surgical effect should be obviously increased in treatment of intracranial arachnoid cyst with epilepsy.