多脑叶切除联合其他术式治疗半球顽固性癫癎(附18例报告)

目的探讨运用多脑叶切除联合多软膜下横纤维切断术(MST)或／和胼胝体部分切开术治疗脑电图 提示为单侧半球为主的多脑叶或半球弥漫性癎灶患者的手术疗效。方法 回顾性总结、分析采用多脑叶切除联合 MST或／和胼胝体部分切开术所治疗的具有半球(为主)多脑叶或半球弥漫性癎灶的18例重型顽固性癫癎患者。结 果本组术后随访1～5年,平均2年。疗效按Engel的标准评定,I级(术后即无癫癎发作)11例;Ⅱ级(每年仅1 ～2次发作)3例;Ⅲ级(发作频率减少75％以上)2例;Ⅳ级2例,总有效率16／18;效果优良14／18,无于术死亡。结 论采用多脑叶切除联合其他术式治疗具有半球(为主)多脑叶或弥漫性癎灶的重型顽固性癫癎具有疗效好、并发 症相对较少等优点,比大脑半球切除术具有更广泛的适应证。

Treating hemispheric intractable epilepsy with multilobar resection in combination with other operations

Objective To evaluate the effect of multilobar resection in combination with multiple subpial transection (MST) or/and corpus callosotomy on hemispheric -dominant multilobar or diffuse epileptogenic focus. Methods The operation results of 18 patients with severe intractable epilepsy were retrospectively analyzed. Results All patients were followed up one to five years, mean two years. Postoperative seizure outcome was classified according to Engel's four categories by an epileptogogist. Class I (seizure - free) indicates an absence of seizure activity postoperafively in 11 cases . Class II indicates rare seizures; that is , a few seizures in a year in 3 cases. Class III indicates worthwhile improvement ,meaning at least a 75% improvement in seizure frequency comparted with preoperative status in 2 cases. Class IV denotes on worthwhile improvement in 2 patients. Gross efficiency rate is 16/18 of patients, conspicuous efficiency rate is 14/18 of patients, No death. Conclusions Multilobar resection in combination with other operations is a suitable way to treat hemispheric -dominant multilobar or diffuse intractable epilepsy owing to good results and less complication, and can widely used in contrast to hemispherectomy.