顽固性癫痫的组合手术治疗  

Combined operations for the treatment of intractable epilepsy

作　　者：魏社鹏[1] 张巍峰[1] 丁侃[1] 王翔[1] 郭辉[1] 

机构地区：[1]同济大学东方医院神经外科,上海200120

出　　处：《中华神经医学杂志》2007年第9期946-950,共5页Chinese Journal of Neuromedicine

摘　　要：目的对部分顽固性癫痫病人,在严格充分的术前评价之后,依据结果将几种手术方式适当的组合使用,并对其临床效果进行评价。方法对同济大学东方医院神经外科收治的116例顽固性癫痫中的25例病人施行联合手术的治疗方法。发作形式为全身强直—阵挛性发作、复杂部分性发作及失神发作等,其中有14例存在两种发作形式。术前均服过多种抗癫痫药,病程后期同时服用2～3种抗癫痫药。25例病人术前均行24 h脑电监测及头颅MRI检查,有19例术前行硬膜下皮层电极和深部电极检测,其中1例行头颅PET检查。手术在皮层脑电及深部电极监测下进行。13例行额颞开颅,颞前叶及海马、杏仁核切除+额部部分区域的软膜下横切术(MST),其中7例附加胼胝体前部切开术;11例行额部开颅,额部软化灶切除+运动区MST,其中2例附加胼胝体前部切开术;1例行双侧枕顶部开颅,左枕叶萎缩皮层切除+胼胝体后部切开+右侧顶枕的MST。结果术后无死亡及严重并发症。术后抗癫痫药物使用减少,术后23例服用一种抗癫痫药,2例服用两种抗癫痫药术后随访6～12个月,17例手术效果为Engel 1级,4例为Engel 2级,4例为Engel 3级。40岁以下的患者手术后癫痫控制的可能性显著大于40岁以上者(P<0.05):病程在10年以下的患者术后癫痫无发作的可能性显著大于10年以上者(P<0.05)。头颅MRI上有无明显的结构异常对病人的预后没有影响(P>0.05)。结论在严格术前评价的前提下,尤其是在有精通神经电生理知识的神经外科医生综合分析下,采用多种手术方式组合治疗顽固性癫痫效果显著。Objective Several surgical methods were applied in combination after sufficiently and strictly assessing some of the patients with intractable epilepsy beforehand and the clinical efficacies of the combined operations were evaluated. Methods Twenty-five of the 116 cases with intractable epilepsy, who had been treated within 13 months in the department of neurosurgery of East Hospital, Tongji University, were performed on by combined operations. As for the 25 cases, seizure types included generalized tonic-clonic seizures, complex partial seizures and absentia, and among the 25 cases, 14 had two of the above seizure types. The 25 cases were all administered with multiple antiepileptic drugs in total before operations, especially during the later stage of the disease course, when 2 to 3 antiepileptic drugs were given to them simultaneously. All the 25 cases received preoperative 24 h electroencephalography （EEG） monitoring and cerebral magnetic resonance imaging （MRI） scan, among which 19 had preoperative subdural and depth electrode investigation and 1 had brain positron emission tomography （PET） scan. The operations were performed with the monitoring of cortex EEG and depth electrodes. A total of 13 cases were treated with resection of the anterior temporal lobe, hippocampus and amygdale ＋ multiple subpial transection （MST） in some regions of the frontal part, assisted with the craniotomy of the frontotemporal lobe, among which 7 also underwent anterior corpus callosotomy; 11 cases received resection of softening lesions in the frontal part ＋ motor area MST, assisted with the craniotomy of the frontal part, among which 2 also underwent anterior corpus callosotomy; 1 case was performed on with resection of shrunk cortex in the left occipital lobe ＋ posterior corpus callosotomy ＋ right parieto-occipital MST, assisted with the craniotomy of bilateral parieto-occipital regions. Results No postoperative death or serious complications occurred. Less antiepileptic drugs were given to the 25 case

关 键 词：顽固性癫痫 外科治疗 

分 类 号：R742.1[医药卫生—神经病学与精神病学]