颅脑术后继发癫痫的外科治疗(附25例临床分析)  

Surgical treatment of secondary epilepsy after craniocerebral operation: a report of 25 cases

作　　者：苏崇德[1] 于龙[1] 徐学军[1] 王瑞峰[1] 鹿鹏[1] 刘冲[1] 艾卿[1] 赵静静[1] 吴向利[1] 牛建伟[1] 常鹏飞[2] 

机构地区：[1]空军航空医学研究所附属医院神经外科癫痫中心,北京100089 [2]解放军309医院神经外科,北京100091

出　　处：《解放军医学杂志》2013年第3期214-216,共3页Medical Journal of Chinese People's Liberation Army

摘　　要：目的探讨颅脑术后继发的难治性癫痫的术前评估方法及适应证选择,总结二次开颅手术切除致痫灶的经验,以提高颅脑术后继发癫痫的治疗效果。方法 2005年1月-2012年5月行手术治疗的颅脑术后继发癫痫患者25例,术前认真评估,仔细询问病史,并行视频脑电图(V-EEG)检查,每位患者均接受发作期和发作间期脑电图检查,或颅内埋置硬膜下电极。根据脑电图、MRI、CT平扫及加强扫描确定癫痫病灶。手术按原颅脑手术切口入路,切开硬脑膜,充分显露脑瘢痕区,采用皮层电极详细探测致痫灶棘波区的位置及范围,在显微镜下一并切除脑组织瘢痕和致痫灶,切除后再次采用皮层电极监测,直到脑电节律正常为止。结果 25例手术均顺利,无死亡病例,无严重手术并发症。术后随访6个月～7年,发作控制EngleⅠ级18例,EngleⅡ级5例,EngleⅢ级2例;18例(72%)无发作,其中9例已停药。结论颅脑术后继发癫痫药物治疗效果欠佳,二次开颅手术可取得满意疗效。Objective To explore the preoperative evaluation and operative indications for intractable secondary epilepsy after craniocerebral operation, and to summarize the experiences of second craniotomy for epileptogenic zone resection, so as to improve the treatment efficacy of epilepsy secondary to neurosurgery. Methods From Jan. 2005 to May 2012, a total of 25 patients with secondary epilepsy after craniocerebral operation were evaluated carefully by assessment of medical history and pre-operative video electroencephalograpby （VEEG） examination. Electroencephalography or implantation of subdural electrodes for localizing the epileptogenic zone was conducted in each patient during and after epileptic attack. The epileptogenic zone was confirmed by electroencephalography, MRI and CT scanning before the second operation. The operation was performed along the original incision for complete exposure of the brain scar zone. After localization of the position and range of spike waves with cortical electrodes, the brain scar and epileptogenic focus were removed microscopically. After resection, re-examination was conducted with the cortical electrodes till brain wave rhythm became normal Results No death or severe complication was found in the 25 patients. During a follow-up period of 6 months to 7 years, 18 patients were seizure free （Engers class Ⅰ ）, 5 patients were Engel＇s class Ⅱ, and 2 patients were Engers class Ⅲ. No post-operative attack was found in 18 cases （72%）, and 9 of them had their drugs withdrawn. Conclusion The medication effect of secondary epilepsy after craniocerebral operation is far from perfect, and second craniotomy could attain satisfactory results.

关 键 词：神经外科手术 癫痫 创伤后 手术后并发症 

分 类 号：R651.11[医药卫生—外科学]