脑皮层热灼治疗功能区癫痫的可行性研究  

A Pilot study of bipolar coagulation on funcional cortexes for treatment epilepsy

作　　者：栾国明[1] 张伟丽[1] 闫丽 王忠诚 

机构地区：[1]北京市神经外科研究所,100050

出　　处：《中华神经外科杂志》1999年第6期329-332,共4页Chinese Journal of Neurosurgery

摘　　要：目的（１）研究猴脑运动区皮层经电凝热灼后其功能及病理学改变。（２）研究低强度电凝热灼对癫痫患者不同部位脑皮层的损伤程度，探讨应用大脑皮层横行纤维破坏来控制功能区顽固性癫痫发作的可行性。方法（１）用电凝功率８～１２Ｕ热灼猴中央前回运动区皮层，饲养不同时间，观察动物的行为、ＭＲＩ、组织病理学及超微结构的改变。（２）采用双极电凝输出功率为低于８Ｕ，对癫痫患者的脑皮层进行热灼，并切除热灼皮层进行急性病理学分析。结果（１）饲养期间动物的饮食、活动等均同术前；处死前的脑部ＭＲＩ检查正常；脑组织的病理学表现主要为浅表皮层（Ｉ－Ⅱ）的热凝损伤及胶质细胞增生，而深部皮层结构正常；电镜下主要为退变神经元，饲养６个月后动物的病变组织逐渐恢复正常。（２）癫痫患者脑浅表皮层（Ⅰ－Ⅱ）有不同程度的热凝损伤，其下相邻皮层的神经元固缩，核深染，而深层（ＩＶ－ＶＩ）组织结构正常。结论提示热灼可使多处浅皮层内的横行纤维变性，从而可能阻止癫痛放电水平方向的同步化和传播，同时该皮质的正常功能仍可能保留。因此热灼的治疗方法安全可行，可在临床上进一步试用。ebjective (l) Low dosage of bipolar coagulation on of bipolar coagulatio n on cerebral motor cortex in 3 monkeys forobserving the post operative activities and pathological ativities and pathological changes. (2) To study the degree of injury in different brain regions after coagulation lesions. Methods (l) Surfaces of multiple cerebrad motor cortexes were coagulated by bipolar in the power rate of 8~12U.The activities of behavior, MRI scan of brain, changes of pathology and ultrastructure were analysed during the different period of post operation. (2) An acute pathological analysis in & patients withepilepsy was performed. Hematoxylineosin (HE) stain was used to assess general pathological features. Resilts Thediet and activities of daily living sere the same as before operation in all monkeys. MRI scan were nounal. Pathological featires in monkeys and and patients indicated that there were coagulation necrosis in superficial layers and acute knosis and tissue edema adjacent to the superficial layers. The structure of deep cortex was normal Conclusions. These results suggested that thermal coagulated lesions could Produce fiber damage in superfical layers and thus wouldprevent horizontal Synchroniztion and spread of epileptic discharges,Therefore,this methhod is is safe and available for oboeal apply.

关 键 词：癫痫 皮层热灼 多软膜下横切术 外科手术 

分 类 号：R742.105[医药卫生—神经病学与精神病学]