顽固性癫痫的外科治疗

目的：探讨术中在皮质和深部脑电图监测下顽固性癫痫的致痫灶定位及术式选择。方法：38例患者根据术前致痫灶的定位和术中皮质及深部电极的监测，分别采用不同的术式：(1)单纯致痫灶切除2例；(2)多软膜下横切术(multiple subpial transection，MST)8例；(3)致痫灶切除4-MST18例；(4)前颞叶、杏仁核-海马切除5例，神经导航下选择性杏仁核-海马切除1例；(5)胼胝体切开4-MST4-皮质热灼4例。结果：38例患者经3～30个月的随访，满意12例(31．6％)，显著改善10例(26．3％)，良好6例(15．8％)，效差4例(10．5％)。无改善6例(15．8％)。总有效率73．7％，治愈率达31．6％。无一例致残或死亡。结论：术中在皮质和深部脑电图监测下，对致痫灶准确的定位和采用不同的术式切除是治疗顽固性癫痫的有效途径。

Surgical treatment in 38 patients with intractable epilepsy

Objective To investigate the location of epileptogenic focus and selection of appropriate surgical methods in treating intractable epilepsy utilizing intraoperative electrocorticograpy(ECOG)and depth electrodes during surgery. Methods According to the preoperative location of epileptogenic focus and guidance of intraoperative ECOG and depth electrodes. Thirty eight patients were performed with different surgery including epileptogenic focus elimination in 2 cases; Multiple subpial transection (MST) in 8 cases; Combining epileptogenic focus elimination and MST in 18 cases; Combining anterior temporal lobectomy and amygdalo hippocampectomy in 5 cases , selectively amygdalo hippocampectomy under neuronavigation in 1 case; Combining callosotomy, MST and bipolar coagulation on functional cortexes in 4 cases. Results All patients were followed up from 3 to 30 months postoperatively , satisfactory outcome in 12 cases (31.6%),marked improvement in 10 cases (26.3%),improvement in 6 cases (15.8%) , slight improvement in 4 cases (10.5%) and no improvement in 6 cases (15.8%). The total effective rate was 84.2%,the excellent result was 31.6%. There was no neurological damage and no mortality caused by the procedure. Conclusion It is a useful way to select appropriate surgical methods during therapy for intractable epilepsy utilizing intraoperative ECOG and depth electrodes.