致痫灶综合定位在顽固性癫痫手术治疗中的价值

目的探讨致痫灶综合定位在提高药物难以控制的顽固性癫痫手术疗效中的作用。方法30例药物难以控制的顽固性癫痫患者拟手术治疗,患者均于术前颅内埋置电极定位致痫灶,术中应用皮层和深部电极验证棘波灶位置,于显微镜下进行致痫灶切除。其中颞叶前极加海马切除14例、单纯病灶切除3例、单纯颞叶切除2例、选择性海马切除3例、病灶切除 单纯软膜横行纤维热凝6例、胼胝体切开2例。患者术后随访2年以上。结果30例患者术中验证棘波灶位置与术前定位位置相同。患者的治愈率为60%,总有效率为90%,无手术死亡及偏瘫等严重并发症。结论利用术前埋置电极和术中皮层及深部电极综合定位致痫灶,可以提高药物难以控制的顽固性癫痫的手术治愈率和有效率。

Value of Epileptogenic Zone Localization in Surgery for Patients with Intractable Epilepsy

Objective To analyze the effect of epileptogenic zone localization in the surgery for patients with intractable epilepsy. Methods Thirty patients with intractable epilepsy were performed operations with preoperational electrodes implantation,and intraoperational cortex and deep electrodes were used for localizing the epileptogenic zones.Fourteen patients undertook temporal lobectomy plus hippocampectomy,3 epileptogenic zone resection only,2 temporal lobectomy only,3 selective hippocampectomy,6 epileptogenic zone resection plus multiple subpial transection,and 2 corpus callosotomy.All the patients were followed up for more than 2 years. Results The cure rate was 60% and the total effective rate was 90%.No death and other major complications were observed. Conclusion(Preoperational) electrode implantation and intraoperational epileptogenic zone localization by cortex and deep electrode can improve the cure rate and effective rate for patients with intractable epilepsy.