三步法定位并多术式联用显微外科手术治疗难治性癫痫

目的探讨难治性癫痫致痫灶定位和手术治疗方法。方法对81例难治性癫痫患者综合运用临床症状学、神经电生理、高场强MRI、PET/CT、术前及术中皮层及深部电极等三步法定位致痫灶,单纯病灶切除、病灶切除加胼胝体切开、病灶切除加软膜下横切、病灶切除加单脑回灰白质联合切除等多术式联用切除致痫灶和/或阻断传导通路。结果三步法致痫灶定侧准确率100%。多术式联用治疗后,满意31例,显著改善17例,良好16例,效差14例,无改善3例,总有效率79.0%。结论三步法可以对致痫灶精确定位,多术式联合处理致痫灶或/和传导通路可以取得良好的疗效。

Three steps located epilepsy focus and combinated of multiple microsurgical operation modes treatment of refractory epilepsy.

Objective To explore the localizations of epilepsy focus and the methods of microsurgical operative treatment for refractory ep- ilepsy. Methods 81 patients with refractory epilepsy were treated by a combination of multiple microsurgical techniques. The epileptogenie focus were localized by the integrated use of clinical symptoms, cortical neural electrophysiology, high field MRI, PET/CT, preoperative and intraopera- tive deep electrode. Multi mierosurgical treatment associated with simple excision, excision plus callosotomy, tumor excision with subpial transec- tion, tumor excision with single brain gray matter induced by combined resection, resection the epileptic foei and / or blocking the pathway were used in the treatment of the focus. Results The epilepsy focus was precisely located to 100% by the three steps methods. The outcomes showed that 31 patients had satisfactory results. Seventeen patients had noticeable improvements and 16 patients had a good therapeutic result. Fourteen patients showed a poor therapeutic result, and 3 patients had no change in symptom and sign. Total effective rate of treating 81 patients with refrac- tory epilepsy is 79.0%. Conclusion Application of three steps method preoperative precisely localized the epilepsy for surgical treatment meth- ods. The result of treating refractory epilepsy had a satisfactory effect.