多病灶难治性癫痫的术前定位和手术疗效分析

目的 探讨多病灶难治性癫痫的临床特点、术前定位、术后疗效及手术相关并发症。方法 回顾性分析苏州大学附属第一医院癫痫中心2013年7月至2018年 4月11例多病灶难治性癫痫患者的临床资料, 根据患者临床症状学、长程视频脑电图（long term video EEG monitoring，VEEG）、磁共振成像（magnetic resonance imaging, MRI）、正电子发射计算机断层成像（PET CT）、PET/MRI融合等进行综合术前评估，术中在皮层脑电监测（ECoG）下行局部病灶或扩大脑叶切除术。术后按Engel分级进行评分，并进行随访。结果 11例患者中软化灶7例，瘢痕性脑回1例，脑裂畸形1例，软化灶合并瘢痕性脑回2例。术后随访3~60个月，Engle分级：Ⅰ级7例（63.6%），Ⅱ级2例（18.2%），Ⅲ级1例（9.1%），Ⅳ级1例（9.1%）；63.6%患者无发作，总有效率为90.9%。术后2例出现颅内感染，1例合并脑积水；1例出现原有视野缺损加重；1例出现右侧肢体偏瘫；无死亡病例。结论 对于多病灶难治性癫痫，根据精准的术前评估后行手术治疗可获得良好的预后。

Preoperative localization and surgical outcome analysis of multifocal refractory epilepsy

Objective To investigate the clinical features, preoperative location, postoperative efficacy and surgical complications of multifocal refractory epilepsy.Methods The clinical data of 11 patients with multifocal refractory epilepsy from July 2013 to April 2018 in the Epilepsy Center of the First Affiliated Hospital of Soochow University were retrospectively analyzed, and all the paitents were conducted long term Video EEG monitoring (VEEG), magnetic resonance imaging (MRI), positron emission computed tomography (PET CT) and PET/MRI coregistration. Local lesions or enlarging lobectomy was implemented by the monitoring of electrocorticogram (ECoG) during operation．Postoperative scores were performed according to Engel classification and followed up.Results Of 11 patients, encephalomalacia was found in 7 cases, ulegyria in 1 case, schizecephaly in 1 case, encephalomalacia combined with ulegyria in 2 cases. After 3 60 months' follow up, 7 cases(63.6%) fell into gradeⅠ, 2 cases(18.2%) grade Ⅱ, 1 case (9.1%) grade Ⅲ, 1 case (9.1%) grade Ⅳ. About 63.6% of patients had no seizures and the total effectiveness was 90.9%. Of 11 patients, infection was detected in 2 patients, hydrocephalus in 1 patient,aggravated visual field deficits in 1 patient, and right limb hemiparesis in 1 patient; no patients died during the operation. Conclusion For multifocal refractory epilepsy, a good prognosis can be obtained by surgical treatment based on accurate preoperative evaluation.