外科治疗中央区顽固性癫痫

目的探讨累及中央区顽固性癫痫的外科治疗方法，并分析影响预后结果的相关因素。方法回顾性分析2008～2011年手术治疗的25例累及中央区的顽固性癫痫患者的临床资料。所有病例依情况分别结合颅内电极、皮层电刺激功能区描记、神经导航、术中唤醒和术中电生理监测等手段进行病灶、致痫区和功能区定位。结果3例术后出现短暂的对侧肢体肌力下降，2例术后对侧肢体肌力有回升，活动更灵活。术后随访12—24个月：EngelⅠ级16例，Ⅱ级5例，Ⅲ级1例，Ⅳ级3例。结论对累及中央区的顽固性癫痫患者，应在保障安全的前提下尽可能切除致痫灶和病变。颅内电极记录和术中唤醒等技术可用于颅内致痫灶的定位，在术中电生理监测下充分切除病灶及癫痫样放电区对控制癫痫发作效果良好。

Surgery for intractable perirolandic epilepsy (report of 25 cases)

Objective To explore surgical treatment of the intractable epilepsy involving perirolandic area(IEIPA) and the factors related to the curative effect.Methods The clinical data of 25 patients with IEIPA treated by surgery from 2008 to 2011 were analyzed retrospectively.The intracerebral lesions,epileptogenic foci and cerebral functional area were located by the various techniques including intracranial electrodes implantation,cortical electrical stimulation,neuronavigation,intraoperative wake-up procedure,and intraoperative EEG monitoring.Results The muscle power of the limbs contralateral to the lesions decrease in 3 patients and increase in 2 patients after the surgery.The following up from 12 to 24 months showed that of 25 patients,16 received Engel grade Ⅰ outcomes,5 gradeⅡ,1 grade Ⅲ and 3 grade Ⅳ.Conclusions The epileptogenic foci and intracranial lesions should be removed as much as possible by surgery under the prerequisite for the patients’safety in the patients with IEIPA.Intraoperative wake-up procedure and intracranial electrodes implantation may be applied to the location of the epileptogenic foci.The curative effect of surgery on IEIPA is good.