结节性硬化症致难治性癫痫的手术处理

目的探讨手术治疗结节性硬化症所致难治性癫痫的适应证、方法和预后。方法回顾性分析了我院从2002年1月至2006年6月间,采用外科手术治疗10例结节性硬化症伴难治性癫痫的经验。术前评估和术中脑电检查显示为局灶性改变者行致痫灶切除、脑叶切除或多软膜下横纤维切断（MST）。检查提示一侧半球为主多灶性或弥漫性改变者,术中行多脑叶切除为主的联合手术方式。结果本组随访1～4年,平均2.5年。10例患者中有6例获得I级（Engel分级）,3例获得Ⅱ级,1例为III级。平均智商（IQ）从术前的59.6分提高到74.2分。本组3例患者出现暂时性的并发症,无手术死亡。结论外科手术是治疗结节性硬化症所致难治性癫痫的良好手段。表现为单致痫灶的患者预后较佳,虽有多结节,但临床资料、脑电图、影像学资料吻合的多致痫灶亦具有较好的手术效果。

Surgical management of intractable epilepsy incurred by tuberous sclerosis

Objective To investigate the surgical indications,operative procedures and outcomes of intractable epilepsy incurred by tuberous sclerosis（TS）.Methods Ten cases of tuberous sclerosis associated with intractable epilepsy admitted in our hospital between 2002 and 2006 were reviewed.Resection of epileptogenic foci or lobe,and（or）multiple subpial transaction（MST）were performed when a focal epileptic discharge was indicated according to preoperative evaluation and electrocorticogram（EcoG）.But multilobar resection with MST and（or）corpus callosotomy were chosen to deal with hemispheric multiple epileptic foci.Results At follow-up from 1 to 4 years（average 2.5 years）,6 of 10 patients（60%）had outcome of Engel Class I after surgery and 3 patients（30%）presented rare seizure（Engel Class Ⅱ）,and 1 patient got a decrease in seizure frequency（Engel Class III）.Mean intelligence quotient（IQ）improved from 59.6 to 74.2.Temporary complications were observed in three patients and there was no death case.Conclusion Surgical intervention is a good treatment for the intractable epilepsy incurred by tuberous sclerosis.Tuberous sclerosis with single epileptic focus may get good outcome and in patients with multiple epileptic foci good outcomes are followed with the consistency of EEG,clinical and image data.