患侧大脑半球多脑叶离断术治疗难治性癫痫  

Multi-lobar disconnection of cerebral hemisphere for refractory epilepsy caused by cerebral hemispheric lesions

作　　者：常鹏飞[1] 蔡立新[2] 苏崇德[3] 

机构地区：[1]解放军总参谋部总医院(309)神经外科,北京100091 [2]首都医科大学宣武医院功能神经外科 [3]航空医学研究所附属医院癫痫中心

出　　处：《立体定向和功能性神经外科杂志》2011年第6期355-360,共6页Chinese Journal of Stereotactic and Functional Neurosurgery

摘　　要：目的应用患侧大脑半球多脑叶离断术治疗该侧半球性病变导致的难治性癫痫,目的是对保留病变半球基本功能的癫痫患者提出一个有效而实用的术式。方法①大脑半球多脑叶离断术的创新:对患侧大脑半球我们分步骤离断额叶,颞叶、和顶枕叶与丘脑、基底节的联系;通过侧脑室额角和枕角离断胼胝体前后部,只保留中央前后回皮层及其与丘脑、基底节和内囊的联系;通过外侧裂切除岛叶皮层;通过颞角切除海马杏仁核。②利用这一术式我们治疗了5例大脑半球病变引发的难治性癫痫患者。结果该术式在5例患者成功实施。结果证实,该手术创伤小,并发症少,术后病人没有任何加重对侧肢体功能障碍的并发症,癫痫得到有效控制。随访13～20个月,Engel I级3例;II级2例。结论大脑半球多脑叶离断术,是对那些保留运动、感觉和语言功能的半球性病变所致的难治性癫痫患者有效、可靠的治疗选择。Objective It is a great challenge to treat the epileptic patients with extensive cerebral lesions with primary functions partly remained in the pathological side. Here we introduce a new surgical approach, multi-lobe disconnection of cerebral hemisphere in order to control the epileptic seizures and remain the primary functions of the pathological cerebral hemisphere. Methods A） Surgical procedures ： ①Anatomical disconnect the link from frontal lobe to the basal ganglia and inner capsule. ②Exposing the frontal horn of lateral ventricle, and discon- nect the frontal part of corpus callosum. ③Dissecting the lateral fissure, completely cut off the temporal stem and removing the cortex of insula, then get into the temporal horn of the ventricle, resect the hippocampus and amygdala . ④Along the superior temporal gyrus, cut off the links between thetemporal and parietal lobes.⑤ Disconnect the links from parieto-occipital lobes to the thalamus, basal ganglia and inner capsule. At the parietal horn, disconnect the posterior part of the corpus collasum. B） Clinical application, 5 patients with refractory epilepsy caused by extensive cerebral hemispheric lesions underwent the new operation. Presurgical evaluation demonstrated the exist of the primary functions of the pathological hemisphere. Results The new surgical procedure was successfully applied to five patients without any worsening of neurological deficit, remaining the primary functions of the pathological brain. Five patients were followed up for 13-20 months. 3 cases got Engel Ⅰ, and 2 case, Ⅱ respectively. Conclusion Multi-lobe disconnection of cerebral hemisphere is a liable and effective choice of treatment for the refractory epilepsy caused by extensive lesions of cerebral hemisphere.

关 键 词：大脑半球多脑叶离断术 难治性癫痫 手术 

分 类 号：R742.1[医药卫生—神经病学与精神病学]