起源于语言功能区及其附近的难治性癫痫的手术治疗

目的探讨起源于语言功能区及其附近的难治性癫痫术前评估和显微手术治疗的方法。方法16例起源于语言区癫痫患者术前使用了长程视频脑电图、功能磁共振成像（fMRI）等检查，明确癫痫灶与功能区的位置关系，并用中国修订韦氏成人智力量表（WAIS—RC）及语言流畅性试验对患者语言功能进行术前评估，术中使用fMRI神经导航配合皮层脑电描记（ECoG），在保护语言功能区的基础上显微手术切除癫痫灶。术后行视频脑电图及语言功能再评估情况随访。结果16例患者中有2例术后出现了短暂的运动性语言功能障碍，1W内恢复正常。术后1个月、3个月复查脑电图（EEG）：13例正常，3例提示轻度异常EEG。术后3个月随访语言功能及流畅性再评估情况与术前比较无明显差异。结论fMRI神经导航配合ECoG显微手术切除癫痫灶，在治疗癫痫的同时能最大程度地保护语言功能。

Surgical treatment for refractory epilepsy originated from language areas and nearby regions

Objective To explore the pre-operative evaluation and micro-neurosurgical treatment in the patients with refractory epilepsy originated from language areas and nearby regions. Methods A series of 16 patients with refractory epilepsy originated from language areas received pre-operative examinations, including long-term video-electroencephalogram and functional magnetic resonance imaging （fMRI）, to explore the relations between the epilepsy foci and functional areas. Wechsler Adult Intelligence Scale--Revised in China （WAIS-RC） and Word Fluency Test were used to evaluate language functions of the patients. After the pre-operative video EEG and language function assessment, the epilepsy loci were resected with microsurgery by means of fMRI- guided neuronavigation combined with electrocorticography （ECoG） to protect the language areas. Results There were 2 cases with temporal motor language dysfunction after operations, which was reversible within one week. After one and three months, dectrocncephalogram （EEG） reexaminations conducted in all the patients showed that 13 cases displayed normal EEG, while nfild abnormal EEG occurred in 3 cases. No significant difference was found in reevaluation of language functions and fluency 3 months post-operation, compared with that of preoperation. Conclusion fMRI-based neuronavigation combined with ECoG can resect epilepsy foci successfully and protect the language functions to the most extend.