局限性非外伤性脑软化灶相关癫痫的手术治疗  

Surgery for refractory epilepsy caused by non -posttraumatic encephalomalacia

作　　者：赵明[1] 梁树立[1] 李安民[1] 邰军利[1] 张继武[1] 孙雅静[1] 刘娜[1] 

机构地区：[1]解放军总医院第一附属医院神经外科,北京100048

出　　处：《中华神经外科杂志》2010年第6期500-502,共3页Chinese Journal of Neurosurgery

摘　　要：目的 探讨软化灶切除联合多处软膜下横切治疗局限性非外伤性脑软化灶相关癫痫的方法 和效果.方法 28例非外伤性脑软化灶相关癫痫患者根据发作时症状、MRI、发作间期正电子发射计算机断层扫描（PET）和视频脑电图（VEEG）检查,确定致痫灶,进行全软化灶切除,软化灶周边辅以多处软膜下横切.术后随访1年以上,按Engel标准分级评价癫痫控制情况.结果 术后1年,患者达到Engle Ⅰ级6例,Ⅱ级11例,Ⅲ级9例,Ⅳ级2例.软化灶局限、远离功能区、不伴有脑萎缩的患者癫痫控制率（Engle Ⅰ～Ⅱ）在80%以上,优于其他患者（P＜0.05）.结论 全软化灶切除联合多处软膜下横切可安全、有效地治疗非外伤性脑软化灶性癫痫,软化灶局限、远离功能区、不伴有脑萎缩的患者往往预后良好.Objective To analyze the strategy and outcome of complete lesion resection （CLR） and multiple subpial transaction （MST） for epilepsy caused by non - posttraumatic encephalomalacia.Methods 28 cases were treated with CLR and MST according to preoperative magnetic resonance image （MRI）, positive （PET） and 128 - led long - term video EEG. They were followed up for more than 1 year,and their outcome was graded by Engel scales for analysis. Results Grade Ⅰ was observed in 6 cases and Grade Ⅱ in 11 cases, Grade Ⅲ in 9 cases and Grade Ⅳ in 2 cases. Satisfactory seizure control was found in patients with localized encephalomalacia, or far away from eloquent area, or without brain atrophy, more than 80%. Conclusion CLR combined with MST is effective and safe for epilepsy caused by nonposttraumatic encephalomalacia. And the cases with localized encephalomalacia, or far away from eloquent area, or without brain atrophy are likely to have a better outcome.

关 键 词：脑软化灶 癫痫 外科手术 

分 类 号：R742.1[医药卫生—神经病学与精神病学]