皮层脑电图监测下多种术式联合治疗脑软化灶所致的继发性癫痫

目的探讨皮层脑电图（ECoG）监测下脑软化灶所致的继发性癫痫的手术治疗效果。方法25例患者术中通过ECoG定位癫痫灶，手术切除，再根据软化灶部位及ECoG提示的癫痫波释放情况分别进行扩大软化灶切除、皮层热灼术、前颞叶切除术、海马切除术、杏仁核切除术及胼胝体前部切开术。结果25例患者软化灶切除前均可记录到癫痫波，软化灶切除后，即时ECoG监测病变周匣均有癫痫波释放，21例非颞叶癫痫经联合应用不同术式治疗后ECoG监测病变周围不再释放癫痫波，4例颞叶癫痫患者在切除软化灶、前颞叶及海马、杏仁核后加行胼胝体前部切开，术后ECoG监测基本正常。随访总有效率为92．0％。结论ECoG监测多种术式联合治疗脑软化灶所致的继发性癫痫效果良好。

Management of combined multiform operations for epilepsy caused by encephalomalaciaunder the monitoring of electrocorticography

Objective To explore the efficiency of surgical management for epilepsy caused by encephalomalacia under the monitoring of electrocorticography（ECoG）. Methods ECoG monitoring was performed in 25 patients during the resection of malacia. The enlarged malacia resection, cortic＇,d thermocoagulation, anterior temporal lobetomy, resection of amygdaloid nucleus, hippocampectomy and anterior callosotomy should be underwent according to the clinical manifestations of seizure, the location of malacia and epileptic wave form discharges detected by intraoperative ECoG. Results Tile epileptic waveform discharges were detected before malacia resection in 25 patients, and there were still epileptic wave at the peripheral areas of tile nidus in immediately postoperative ECoG monitoring. Epileptic wave disappeared in 21 of non-temporal epilepsy after different combined operations, 4 patients with temporal epilepsy had good ECoG monitoring findings ＇after combined resection of malacia, hippoeampus, amygdaloid nucleus and anterior temporal lobe with additional anterior eallosotomy. The total effective rate was 92.0%. Conclusion The surgie＇,d management of combined multiform operations can get ideal curative effect for the patients with epilepsy caused by encephalomalacia under the monitoring of electrocortieography.