外伤后顽固性癫痫手术治疗  

Surgical Teatment in Patients with Post-traumatic Intractable Epilepsy

作　　者：潘进钱[1] 谢文霞[1] 张晓微[1] 

机构地区：[1]浙江省温州医学院附属第一医院神经外科,325000

出　　处：《医学研究通讯》2005年第4期42-44,共3页Bulletin of Medical Research

摘　　要：目的评价多种手术方法联合使用治疗外伤后顽固性癫痫的效果。方法 21例患者根据术前致痫灶的初步定位和术中皮质脑电及深部电极的监测结果,分别采用以下5种不同的术式:①瘢痕及周围皮质切除7例;②瘢痕及周围皮质切除+多软膜下横切术(MST)8例;③前颞叶、杏仁核-海马切除4例;④神经导航下选择性杏仁核-海马切除1例;⑤胼胝体前部切开+MST+皮质热灼1例。结果术后随访3个月～10年,疗效满意的9例(43%),显著改善的7例(33%),良好的3例(14%),效差的1例(5%),无改善的1例(5%)。术后无死亡病例,有8例出现暂时性的功能障碍,但均在4周内恢复正常。结论多种手术方法联合治疗外伤后顽固性癫痫安全有效。Objective To evaluate the surgical outcomes of the combined several operations for post-traumatic intractable epilepsy during one surgery.Methods According to the preoperative tentative location of epileptogenic focus and the guidance of intraoperative electrocor- ticography and depth electrodes,21 seizure patients were performed with different surgery,including ①epileptogenic focus resection in 7 cases; ②epileptogenic focus resection combined with multiple subpial transection(MST)in 8 cases;③anterior temporal lobectomy combined with amygdalo-hippocampectomy in d-cases;④selective amygdalo-hippocampectomy was performed under neuronavigation in 1 case;⑤anterior callosotomy combined with MST and bipolar coagulation on funtional cortexes in 1 case.Results 21 patients were followed up from 3 months to 10 years postoperatively,satisfactory outcome in 9 cases(42.9%),marked improvement in 7 cases(33.3%),improvement in 3 cases(14.3%), slight improvement in 1 case(4.8%)and no improvement in 1 case(4.8%).There was no mortality caused by the procedure.8 cases had side -effects temporarily,but all recovered in four weeks after surgery.Conclusion For post-traumatic intractable epilepsy,the combined several operations is effective on seizure control and as safe as regular seizure surgery.

关 键 词：顽固性癫痫 外伤后 手术治疗 多软膜下横切术 胼胝体前部切开 手术方法 联合使用 监测结果 深部电极 神经导航 术后随访 死亡病例 功能障碍 联合治疗 杏仁核 皮质 切除 致痫灶 前颞叶 暂时性 多种 周围 瘢痕 海马 

分 类 号：R742.1[医药卫生—神经病学与精神病学] R651.15[医药卫生—临床医学]