难治性枕叶癫痫的手术治疗（附7例报告）

目的分析难治性枕叶癫痫的手术治疗效果和视觉功能保护效果。方法对7例难治性枕叶癫痫患者,行视力视野检查,致痫灶行皮层或局部病灶及周围胶质增生带切除术,对5~10 s内迅速跟随发作起始的症状产生区行低功率皮层热灼术或局部皮层切除术,疑有功能区放电或发作起始者加行脑磁图功能区定位,功能区行低功率皮层热灼术,并注意保护好其白质传导纤维。其中确定发作起始于功能区的2例行功能区皮层热灼术。根据Engel′s术后效果分级评估疗效;行视力视野检查,观察术后患者视觉功能变化。结果术后随访6-12个月,6例无癫痫发作,达到Engel′sⅠ级,1例术后存在稀少癫痫发作,达到Engel′sⅡ级。6例（包括行功能区皮层热灼术2例）术后视觉功能无明显变化,1例视觉功能障碍较术前加重。结论定位明确的难治性枕叶癫痫患者可行致痫灶皮层或局部病灶及周围胶质增生带切除术;功能区低功率皮层热灼术可有效控制癫痫发作,且不造成功能缺失。术前精确定位功能区,术中保护功能区皮质及白质传导纤维,可有效减少视觉功能损伤机会。

Surgical treatment of intractable occipital lobe epilepsy(7 cases report)

Objective To analysis the effect of refractory occipital lobe epilepsy surgery and its visual protective effect.Methods Seven patients with refractory occipital lobe epilepsy,were treated by epileptic focus resection and surrounding cortex lesions or local gliosis focus resection,their sight and vision were inspected.The region emerging symptomin 5~10 s was treated by low region power cortex bipolar coagulation or partial cortical resection surgery.The cases of discharge or the onset of functional areas were added starting line MEG localize functional areas and functional areas of low-power Cortex-line bipolar coagulation technique were given,and attention to protecting the conductive fiber of its white matter.Two cases of attack began in the functional areas were treated by regular functions cortex bipolar coagulation technique.The curative effect was evaluated according to Engel′s classification,and the changes in visual function was observed.Results Followed up for 6 to 12 months,6 patients had no seizures（Engel′s Ⅰ grade）,1 patient had few seizures（Engel′s Ⅱ grade）.6 cases（including the line of functional cortex of bipolar coagulation in 2 cases） had no significant changes in visual function after surgery,1 patient′s visual funition obstacles aggravated than that preoperative increased.Conclusions The epileptogenic and gliosis focus resection are feasible to the well-localizd occipital lobe epilepsy patients.Low-power bipolar coagulation technique can control the seizures effectively,without causing loss of function.Surgery functional areas before the precise positioning,intraoperative protection of cortex and white matter conduction fibers can effectively reduce the visual dysfunction.