额叶离断术治疗无影像学异常的难治性额叶癫痫  

Frontal lobe disconnection for intractable frontal lobe epilepsy of normal imageology

作　　者：郭效东[1] 王本瀚[1] 吴艳芝[1] 刘明辉[1] 陆卫风[1] 郝文明[1] 王振华[1] 赵鸽[1] 杨俊国[1] 

机构地区：[1]解放军第153医院全军神经外科中心,郑州450042

出　　处：《中华神经外科杂志》2013年第5期512-515,共4页Chinese Journal of Neurosurgery

摘　　要：目的探讨额叶离断术治疗无影像学异常的难治性额叶癫痫的可行性、有效性、并发症及适应证。方法2006年6月至2012年1月解放军第153医院全军神经外科中心对12例无影像学异常的难治性额叶癫痫患者，采用额叶离断术治疗，对手术适应证的选择、手术方法、离断范围、额叶功能区的保护方法、手术效果以及并发症进行总结分析。12例患者中，10例行单纯额叶离断，2例一侧额叶离断后皮质脑电图（ECoG）监测发现离断部位后缘仍有癫痫波，加行胼胝体前部切开术。结果5例术后出现短暂精神、记忆及性格改变，2例出现一侧肢体轻度偏瘫，均于1个月内恢复正常。无颅内出血、感染及严重并发症。随访1．0～5．5年，EngdⅠ级9例，Ⅱ级3例。结论在术中直接皮层电刺激技术及ECoG监测下，采用额叶离断术治疗无影像学异常的难治性额叶癫痫，是一种安全有效的手术方法。Objective To explore the feasibility, efficiency, complications, and indications of frontal lobe disconnection for intractable frontal lobe epilepsy of normal imageology. Methods 12 patients with intractable frontal lobe epilepsy of normal imageology were performed by frontal lobe disconnection from June 2006 to January 2012 in the Department of Neurosurgery, 153rd Hospital of PLA. The data of indications, operative methods, boundary of disconnection, protection of functional areas, efficiency, and complications were analyzed retrospectively. Simple frontal lobe disconnection were found in 10 cases, frontal lobe disconnection, and anterior callosotomy in 2 cases based on the results of eiectrocorticography （ECoG） monitoring, which found a lot of residual in the form of epileptiform discharge in the posterior border of the disconnection lines. Results 5 patients developed transient mental dysfunction, recent memory degression, and character change while 2 patients showed complicated mild . One side of limbs hemiparalysis after operation. However, all patients recovered in one month. No permanent and severe complications were noted. All patients were followed up for 1.0 to 5.5 years, according to Engel＇ s classification standards. Engel Ⅰ was noted in 9 patients and Engel Ⅱ in 3. Conclusions It is a safe and effective management for frontal lobe disconnection combined with intra - operative ECoG and cortical electrical stimulation for intractable frontal lobe epilepsy of normal imageology.

关 键 词：额叶离断术 难治性癫痫 额叶癫痫 并发症 

分 类 号：R742.1[医药卫生—神经病学与精神病学]