病灶及癫痫灶切除治疗器质性癫痫的疗效观察  

Surgical treatment of organic epilepsy by removal focus of primary diseases and focus of epilepsy

作　　者：白海平[1] 武铁[2] 马玉新[1] 杨炎龙[1] 郭军[1] 李增生[1] 第五飞虎[1] 胡彪[1] 

机构地区：[1]解放军第323医院,陕西西安710054 [2]解放军第451医院,陕西西安710054

出　　处：《宁夏医学杂志》2005年第9期623-624,共2页Ningxia Medical Journal

摘　　要：目的研究器质性癫痫的病变组织切除后,癫痫灶是否随之消失,异常的脑电波形范围(距离)及波形特旆。方法随机取首发症状为癫痫的脑内有器质性病灶的患者11例。手术方法:切除病灶的同时,在EcoG的监测下行致痫灶切除(如在功能区则行MST),复查至癫痫波消失后方结束手术。随访3-37月,术后要求患者抗癫痫治疗至少1年。结果①手术中,病灶均成功切除;②病理见脑囊虫病3例,AVM 2例,脑肺吸虫1例,脑胶质瘤2例,蛛网膜囊肿2例,脑炎性肉芽肿1例;③10例经EcoG、DeepEEG检查发现有癫痫样异常波形(10/11),所发现的异常波形以尖波为多见,棘波仅2例,在残腔周围0.5-5cm范围,深亦可达5cm;④随访11例中,1例胶质瘤患者死亡(术后4个月,死于胶质瘤复发),余均健在。癫痫症状发作情况:发作消失7例,1-2次/年2例,发作减少75%1例,发作减少50%1例。结论以癫痫为首发症状的器质性癫痫患者,仅切除原发病灶,并未能消除致癫痫病灶,可为术后癫痫发作埋下隐患,有条件时,应在切除原发病灶的,同时切除致痫灶。Objective To investigate the experience in after removal the focus of the primary disease, the abnormal wave disappearance of not.What is the feature of the abnormal waves. Methods An analysis was made of 11 patient（7 male, 4 female, age ranged 12-47y）, clinic attack as the first comploain. Discase couse last 7d-26y ; At the same time, removal focus of primary discase and docus which cause the epilepsy under monitoring of EcoG/Deep needle EEG.The method of opration is corticectomy for focus of epilepsy and/or multiple subpartial transection （functional area）. Result Removal the focus of primary disease in all patients. EcoG/Deep EEG shows abnormal waves in 10 cases（10/11）, Shape wave in 8 and spick wave in 2 cases. Range form 0.5-5.0cm, deep to 5cm.The follow-up results of 11 patients showed a complete seizure control obtained in 7 cases（63.64%） ;obvious decreased in 2 （18.18%） ; decreased in 1（9.09%）, and less control 1（9.09%）. 1 cass died of 4m after operation with the recurrence of glioma. Conchtsion Results shows us that not only pay attention to the removal of the primary disease but to the focus which cause the epilepsy attack in clinic.

关 键 词：癫痫 外科治疗 病灶 

分 类 号：R742.1[医药卫生—神经病学与精神病学]