开颅手术治疗顽固性癫癎138例分析  

Analysis of surgical treatment on 138 cases of intractable epilepsy

作　　者：黄庆玖[1] 常义[1] 马骏[1] 刘宏毅[1] 何升学[1] 张锐[1] 胡波[1] 杨纶先[1] 

机构地区：[1]南京医科大学附属脑科医院神经外科,210029

出　　处：《临床神经外科杂志》2007年第1期24-26,共3页Journal of Clinical Neurosurgery

摘　　要：目的评价顽固性癫癎的致癎灶定位方法和皮层电极监测下致癎灶切除,加行多处软脑膜下横纤维切断术(MST)治疗癫癎的疗效。方法对138例顽固性癫癎病人的致病灶,采用CT+MRI+EEC+单光子发射计算机体层摄影(SPECT)+皮层脑电图(ECoG)联合检测定位。对检出的阳性病灶在皮层电极监测显微镜下行致癎灶切除,切除后检测仍有癫癎波者加行MST;致癎灶位于重要功能区者单行MST。结果致癎灶阳性检出率86%。皮层电极监测显微镜下致癎灶切除加MST,术后91%的病人癫癎发作停止,一年后约15%的病人复发,但症状较术前减轻,持续时间较术前短。结论CT+MRI+EEG+SPECT+ECoG联合检测,对手术定位具有较高价值。皮层电极监测下致癎灶切除术及MST创伤轻微、效果比较可靠、治愈率高、并发症少、复发率低。病灶及致癎灶的不完全切除和形成皮层软化及疤痕,可能是导致癫癎复发的重要原因。Objective To evaluate the accuracy of localization of intractable epileptiogenic lesion and the effect of resection under cortical electroencephalogram（ECoG） together with multiple subpial transection（MST）. Methods 138 patients with intractable epilepsy involved into this study. CT ＋ MRI ＋ EEG ＋ SPECT ＋ ECoG were provided of localization of the responsible lesion before resection. MST was performed on patients who kept demonstrating epileptic EEG waves after the resection. Those with lesion in critical cerebral area were treated with MST exclusively. Results 86% of causative lesions were localized. Microscopic resection plus MST under ECoG resulted in a cessation of epilepsy in 91% of the patients despite that 15% of the patients showed seizures again in half a year which turned to be less severe and shorter in duration. Conclusions CT ＋ MRI ＋ EEG ＋ SPECT ＋ ECoG may contribute to accurate localization for surgery . Resection of epileptic lesion under ECoG together with MST is proved to be less traumatic and reliable in effect with reduced complications and lower recurrence. Epileptic lesion and incomplete resection of it as well as the cortical softened lesion and scars followed the surgical procedure may significantly contribute to the recurrence of epilepsy.

关 键 词：顽固性癫痫 皮层脑电图 致痫灶 软脑膜下横纤维切断术 

分 类 号：R742.1[医药卫生—神经病学与精神病学]