三步法定位并多术式联用显微外科手术治疗难治性癫痫  

Three steps located epilepsy focus and combinated of multiple microsurgical operation modes treatment of refractory epilepsy

作　　者：郁毅刚[1,2] 李君[1,2] 罗飞[1,2] 王文浩[1,2] 张丽霞[1,2] 林宝华[1,2] 

机构地区：[1]解放军第一七五医院 [2]厦门大学附属东南医院南京军区创伤神经外科中心神经外科,福建漳州363000

出　　处：《临床和实验医学杂志》2013年第16期1274-1276,共3页Journal of Clinical and Experimental Medicine

基　　金：全军十一五医学科研基金面上项目(06MB152);漳州市重点科研项目(漳科重2011-018);漳州市科技计划项目(Z10071);南京军区医学科研项目(12MA065)

摘　　要：目的探讨难治性癫痫致痫灶定位和手术治疗方法。方法对81例难治性癫痫患者综合运用临床症状学、神经电生理、高场强MRI、PET/CT、术前及术中皮层及深部电极等三步法定位致痫灶,单纯病灶切除、病灶切除加胼胝体切开、病灶切除加软膜下横切、病灶切除加单脑回灰白质联合切除等多术式联用切除致痫灶和/或阻断传导通路。结果三步法致痫灶定侧准确率100%。多术式联用治疗后,满意31例,显著改善17例,良好16例,效差14例,无改善3例,总有效率79.0%。结论三步法可以对致痫灶精确定位,多术式联合处理致痫灶或/和传导通路可以取得良好的疗效。Objective To explore the localizations of epilepsy focus and the methods of microsurgical operative treatment for refractory ep- ilepsy. Methods 81 patients with refractory epilepsy were treated by a combination of multiple microsurgical techniques. The epileptogenie focus were localized by the integrated use of clinical symptoms, cortical neural electrophysiology, high field MRI, PET/CT, preoperative and intraopera- tive deep electrode. Multi mierosurgical treatment associated with simple excision, excision plus callosotomy, tumor excision with subpial transec- tion, tumor excision with single brain gray matter induced by combined resection, resection the epileptic foei and / or blocking the pathway were used in the treatment of the focus. Results The epilepsy focus was precisely located to 100% by the three steps methods. The outcomes showed that 31 patients had satisfactory results. Seventeen patients had noticeable improvements and 16 patients had a good therapeutic result. Fourteen patients showed a poor therapeutic result, and 3 patients had no change in symptom and sign. Total effective rate of treating 81 patients with refrac- tory epilepsy is 79.0%. Conclusion Application of three steps method preoperative precisely localized the epilepsy for surgical treatment meth- ods. The result of treating refractory epilepsy had a satisfactory effect.

关 键 词：难治性癫痫 致痫灶定位 显微手术 

分 类 号：R742.1[医药卫生—神经病学与精神病学]