经纵裂-透明隔间腔入路胼胝体切开术治疗难治性癫痫的手术方法及临床疗效

目的探讨经纵裂-透明隔间腔入路胼胝体切开术治疗药物难治性癫痫的手术方法和临床疗效。方法回顾性分析2014年1月至2019年1月上海交通大学医学院附属仁济医院功能神经外科收治的23例难治性癫痫患者的临床资料。患者均采用梯形小骨窗开颅,分别经纵裂-透明隔间腔入路行胼胝体前2/3切开术或一期胼胝体全节段切开术。术前行磁共振静脉成像(MRV)和图像三维重建辅助设计切口和骨窗。术后定期行影像学随访,采用Montreal神经研究所和医院Oguni等胼胝体切开术后疗效分级标准评估疗效。结果23例患者均顺利完成胼胝体切开手术,其中11例行胼胝体前2/3切开术,12例行一期胼胝体全节段切开术。23例患者中,22例沿中线切开胼胝体至透明隔腔,仅1例患者因脑发育畸形,术中探查透明隔腔缺失,改用经侧脑室入路切开胼胝体。患者术后均无颅内出血、脑积水和感染,无遗留长期神经功能障碍和并发症。MRI或弥散张量成像复查证实胼胝体切开范围达到要求。所有患者的中位随访时间为1.8年(0.5~5.2年)。术后疗效分级结果:A级4例、B级6例、C级6例、D级7例、E级0例,总有效率为69.6%(16/23)。结论经纵裂-透明隔间腔入路行胼胝体切开术可保持正中的手术路径,从而减少副损伤和并发症的发生,提高手术疗效。

Surgical methods and clinical outcomes of corpus callosotomy through longitudinal fissure-cavum septum pellucidum et Vergae approach for refractory epilepsy

Objective To explore the surgical techniques and clinical outcomes of corpus callosotomy through longitudinal fissure-cavum septum pellucidum et Vergae(L-C)approach for medically intractable epilepsy.Methods A retrospective study was performed of 23 patients with medically intractable epilepsy who underwent corpus callosotomy at Department of Functional Neurosurgery,Renji Hospital,Shanghai Jiaotong University School of Medicine,from January 2014 to January 2019.All patients underwent small trapezoid-shaped craniotomy,anterior two thirds corpus callosotomy or one-stage entire corpus callosotomy through L-C approach.Preoperative magnetic resonance venography(MRV)and three-dimensional reconstruction of images were used to assist in the design of incisions and bone windows.Radiographic follow-up was performed regularly after surgery,and the therapeutic effect was evaluated based on the outcome classification standard of corpus callosotomy proposed by Oguni et al.from Montreal Neurological Institute and Hospital,Canada.Results Twenty-three patients successfully underwent corpus callosotomy.Among those,11 patients underwent anterior two thirds corpus callosotomy and 12 underwent one-stage entire corpus callosotomy.Of the 23 patients,22 underwent corpus callosotomy through the L-C approach,and the approach of corpus callosotomy was switched to trans-lateral-ventricular approach in the remaining 1 case due to its brain developmental abnormality observed during operation,which was a lack of septum pellucidum.There was no intracranial hemorrhage,hydrocephalus or infection after operation,and there was no long-term neurological deficits or complications.Re-examination of MRI or diffusion tensor imaging(DTI)confirmed that the range of corpus callosotomy met the requirements.All patients were followed up for a median of 1.8 years(0.5-5.2 years).Postoperative therapeutic effects were classified as follows:4 cases of grade A,6 cases of grade B,6 cases of grade C,7 cases of grade D,and 0 case of grade E.The total effective rate was 69.6%(16/23).Conclusion The corpus callosotomy through the L-C approach can maintain a central surgical path,thereby reducing the incidence of side injuries and complications,and improving the efficacy of the operation.