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难治性外伤性癫痫的手术治疗分析
引用本文:袁冠前,薛洪利,吕搏川,史学颖,卢乐平,张海峰. 难治性外伤性癫痫的手术治疗分析[J]. 中华神经医学杂志, 2009, 8(1): 605-607. DOI: 10.3760/cma.j.issn.1671-8925.2009.06.018
作者姓名:袁冠前  薛洪利  吕搏川  史学颖  卢乐平  张海峰
作者单位:沈阳军区总医院神经外科,沈阳,110016;
摘    要:目的 探讨外伤性癫痫的临床特点、致痫灶位置与脑软化灶的关系和手术疗效.方法 沈阳军区总医院神经外科自2003年2月至2006年4月共手术治疗难治性外伤性癫痫患者13例,对其临床资料进行回顾性分析. 结果 8例患者致痫灶位于外伤软化灶周围(2~7 cm);5例为颞叶癫痫,其中4例为颞叶内侧型(3例受伤时年龄1.5~5岁,术后病理显示海马胶质细胞增生)、1例为颞叶外侧型.13例患者均在皮层电极监测下行手术治疗,4例同期行颅骨修补术.经2~5年随访,总手术有效率92.3%,优良率84.6%. 结论 外伤性癫痫致痫灶常位于软化灶周围;小于5岁的重型颅脑损伤易导致海马硬化;难治性外伤性癫痫的手术疗效较好,一经诊断,应积极进行手术治疗.

关 键 词:外伤性癫痫   致痫灶   外科手术   

Effect of surgical intervention on refractory posttraumatic epilepsy: a clinical analysis
YUAN Guan-qian,XUE Hong-li,LU Bo-chuan,SHI Xue-ying,LU Le-ping,ZHANG Hai-feng. Effect of surgical intervention on refractory posttraumatic epilepsy: a clinical analysis[J]. Chinese Journal of Neuromedicine, 2009, 8(1): 605-607. DOI: 10.3760/cma.j.issn.1671-8925.2009.06.018
Authors:YUAN Guan-qian  XUE Hong-li  LU Bo-chuan  SHI Xue-ying  LU Le-ping  ZHANG Hai-feng
Abstract:Objective To investigate the clinical characteristics ofposttraumatic epilepsy, the correlation between epileptogenic foci and encephalomalacia, and the therapeutic effects of surgical intervention. Methods A retrospective analysis was performed among 13 patients with refractory post-traumatic epilepsy who received surgical intervention between February, 2003 and April, 2006. Results The first seizure attack occurred 0.5-13 years (mean 5.3 years) after craniocerebral injury in these patients. The epileptogenic loci were located around the encephalomalacia (ranging from 2 to 7 cm) in 8 patients, in the temporal lobe in 5 patients, in the medial temporal lobe in 4 patients (3 of whom sustained the injuries at 1.5-5 years of age with hippocampal glial proliferation shown by postoperative pathological examination), and in the neocortex of the temporal lobe in 1 case. All the patients underwent the operations under close monitoring of the cortical electroencephalogram, and 4 also received cranioplasty. The total effective rate of the surgery was 92.3% with an excellent outcome rate of 84.6% in the follow-up for 2-5 years. Conclusion The epileptogenic loci of posttraumatic epilpsy are usually adjacent to the encephalomalacia, and hippocampal sclerosis can be likely in patients with severe cerebral injury below 5 years of age. gefractory posttraumatic epilepsy often has favorable surgical outcome, and prompt surgery is suggested after the diagnosis.
Keywords:Posttraumatic epilepsyEpilepogenic lociSurgical treatment
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