病灶性难治性癫痫术前评估及手术方法的探讨  

A primary study on preoperative evaluation and surgical management of lesional intractable epilepsy

作　　者：闫红梅[1] 王喆[1] 王寿先[1] 张振兴[1] 王道奎[1] 宋仁兴[1] 宋美香[2] 

机构地区：[1]山东省潍坊市人民医院分院、潍坊市脑科医院神经外科,261041 [2]山东省潍坊市人民医院分院、潍坊市脑科医院脑电图室,261041

出　　处：《中国医师进修杂志（外科版）》2007年第12期15-17,共3页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨病灶性难治性癫痫术前评估和手术治疗的方法。方法对40例病灶性难治性癫痫患者联合应用长程视频脑电图、磁共振成像、功能磁共振成像、磁共振波谱分析等方法进行术前评估，确定致痫灶与病灶的关系，采用单纯病灶切除术、病灶切除加周围皮质切除术、病灶切除加周围皮质软膜下横切术或皮层热灼术等手术方法，随访复查，评价临床效果。结果40例患者术前评估致痫灶与病灶位置基本一致，术中均应用皮层电极监测，与术前评估相符。术后随访11～48个月．EngelⅠ级30例（75．0％），Ⅱ级7例（17．5％），Ⅲ级2例（5．0％），Ⅳ级1例（2．5％）。36例（90％）患者生活质量改善。结论病灶性难治性癫痫，术前需应用长程视频脑电图、磁共振成像、功能磁共振成像、磁共振波谱分析等方法进行评估以明确病灶与致痫灶的关系，采用多种手术方法联合的方法是治疗病灶性难治性癫痫的有效途径。Objective To investigate the methods of preoperative evaluation and the surgical management of lesional intractable epilepsy. Methods Based on the preoperative evaluation,epileptic focus was located by Video-EEG, MRI, fMRI, MRS and removed with different minimally invasive treatments including epileptic focus elimination, multiple lobectomy. Evaluated the effect of operations with the follow-up investigations. Results The onset zone was confirmed to be accurate in the localization with the lesions in 40 cases. All patients were followed up for 11-48 months postoperatively. According to the Engel standard of the curative effect,grade Engel Ⅰ accounted for 75.0% ,grade Ⅱ 17.5%,grade Ⅲ 5.0% ,and grade Ⅳ 2.5%, respectively. Quality of life markedly improved in 36 cases （90%）. Conclusion Based on the preoperative evaluation, epileptic focus located by Video-EEG, MRI, fMRI and MRS, it is an effective way to select appropriate surgical methods for treating the lesional epilepsy.

关 键 词：难治性癫痫 颅内病灶 外科手术 

分 类 号：R742.1[医药卫生—神经病学与精神病学]