中央沟区病变继发癫痫的显微手术治疗  

Surgery for epilepsy secondary to lesions within or near central sulcus

作　　者：王道奎[1] 宋仁兴[1] 王寿先[1] 闫红梅[1] 王增武[1] 王喆[1] 

机构地区：[1]潍坊市脑科医院,山东潍坊市人民医院261021

出　　处：《中华神经外科杂志》2009年第4期327-329,共3页Chinese Journal of Neurosurgery

摘　　要：目的探讨中央沟区病变继发癫痫的显微手术治疗。方法总结35例首发症状为癫痫的中央沟区病变，应用长程脑电图、偶极子、皮层电极定位致痫灶；MRI结合术中皮质体感诱发电位、皮质刺激术定位脑功能区，显微镜下脑沟入路，保护脑功能区，病变切除后功能区残余癫痫波应用脑皮层热灼。结果术后随访1-3年，疗效达到EngelI级31例、Ⅱ级4例、没有Ⅲ、Ⅳ级患者。术后3个月肢体功能障碍较术前改善23例，不变7例，加重5例，无手术死亡。结论准确定位致痫灶和功能区，脑沟入路皮质下切除病变，配合功能区残余癫痫波皮层热灼，能保护肢体功能、控制癫痫的发作。Objective To study the surgical treatment of epilepsy secondary to lesions within or near central sulcus. Methods 35 patients with epilepsy secondary to lesions within or near central sulcus were reviewed retrospectively. The epileptogenic focus was located by EEG, dipole, electrocorticogram. The central sulcus was located by MRI, cortical somatosensory evoked potential and cortical electric stimulation. The lesions were resected along the cerebral sulcus by microsurgery. The cortical thermocoagulation of functional areas was used for residual epileptic waves. Result The patients were follow-uped from one year to three years. The follow-up results showed Engel Class I in 31 cases ,Engel Class II in 4 cases. There was no one with Engel Class m and IV. The neurological functions of patients were improved in 23 cases, unchanged in 7 cases, worsen in 10 cases at 3 month after surgery. There was no died patient. Conclusions Accuratelocalization of the epileptogenic focus and cerebral sulcus, microsurgcry under cortex and cortical thermocoagulation for residual epileptic waves could control the seizure effectively and avoid severe neurological impairments for patients with lesions located within or near central sulcus.

关 键 词：中央沟 病变 癫痫 显微外科手术 

分 类 号：R686[医药卫生—骨科学]