多处软脑膜下横切术治疗小儿顽固性癫痫  

Multiple subpial transection in treating intractable pediatric epilepsy

作　　者：雷霆[1] 舒凯[1] 汤浩[1] 董芳永[1] 李勇[1] 李龄[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院神经外科,武汉430030

出　　处：《中华小儿外科杂志》2005年第4期169-171,共3页Chinese Journal of Pediatric Surgery

摘　　要：目的对40例小儿顽固性癫痫施行多处软脑膜下横切术(MSTs)作回顾性分析.方法 40例小儿经MRI/CT检查证实有病变,其分布如下:中央前回15例;中央后回5例;双侧枕叶视皮质5例;Broca区13例;Wernicke区(角回)2例,所有病变测量均为小于3cm的小病灶.视频EEG/24h EEG检查证实有相应病变的异常放电.全部患儿在全麻下行显微手术,作病变切除及病变周围的致痫灶多处软脑膜下横切术.结果术后中央前后回病变20例病理证实为星形细胞瘤I级18例,海绵状血管瘤2例;双侧枕叶病变5例,病理证实为穿通性脑囊肿1例,神经节细胞瘤3例,星形细胞胶质增生1例;Broca及Wernicke区/回15例,病理证实为星形细胞胶质增生6例,皮质发育不良7例,错构瘤2例.手术并发症:1例帽状腱膜下积液及1例脑内血肿,手术后10d消失或改善.经1 ～2年随访,25例(62.5%)再无癫痫发作(Engel class I级);12例(30%)仍有癫痫发作,但发作程度及频率明显减少或轻微(Engel class Ⅱ级).结论 MSTs对儿童顽固性癫痫是一种有效的手术,特别是辅助于病变的显微手术时,MSTs是可取的.Objective To review multiple subpial transections, (MSTs) as a treatment of 40 pediatric patients with intractable epilepsy.Methods Between 2001 and 2003, the affected patients underwent MRI/CT and the lesions identified. There were 15 lesions in precentral gyrus, 5 in postcentral gyrus, 5 in bioccipital cortex, 13 in Broca area, and 2 in Wernick area. All lesions were smaller than 3 cm. Video EEG/ 24h EEGs performed in all patients were abnormal. The children all underwent microsurgery and periepileptogenic focus resection under general naesthesia.Results Of 39 pathologies demonstrated, there were 18 astrocytoma (class I), 2 cavernoma, 1 porencephalic Cyst, 3 Ganglioglioma, 6 astrogliosis, 7 cortical dysplasia, 2 hamartoma. The Surgical complications included 1 subgaleal fluid collection and one hematoma. 10 days post-operatively. The complication subsided. All patients were follow up for 1 ~2 years, 25 cases (62.5%) were seizure free (Engl Class I), 12 cases (30%) continued to suffer seizures but the level and frequency were significantly milder (Engel Class Ⅱ).Conclusions MST was a good effective operation in treating intractable epilepsy.

关 键 词：多处软脑膜下横切术 顽固性癫痫 小儿 治疗 病理证实 海绵状血管瘤 神经节细胞瘤 皮质发育不良 胶质增生 癫痫发作 回顾性分析 EEG检查 星形细胞瘤 手术并发症 CT检查 中央前回 中央后回 异常放电 显微手术 病变周围 病变切除 

分 类 号：R726.5[医药卫生—儿科]