痫灶切除辅助性脑皮层横行纤维热灼治疗功能区癫痫的临床研究  

A clinical study of resecting the epileptic foci combining with thermoe coagulation to treat the functional cortexes epilepsy

作　　者：栾国明[1] 李云林[1] 闫丽[2] 白勤[2] 孙振荣[1] 周建[3] 张斌[1] 

机构地区：[1]首都医科大学附属北京天坛医院神经外科,100050 [2]北京市神经外科研究所 [3]北京市普仁医院神经外科

出　　处：《中华神经外科杂志》2002年第4期209-212,共4页Chinese Journal of Neurosurgery

摘　　要：目的　采用低功率热灼的方法 ,毁损脑皮层的横行纤维 ,治疗功能区顽固性癫痫 ,观察该方法在临床的实用性和有效性。方法　 12 4例难治性癫痫患者 ,手术切除非功能区致痫灶后 ,辅助热灼功能区的致痫灶或癫痫样放电。非功能区致痫灶切除前后、功能区致痫灶热灼前后均行皮层脑电图监测。病理观察热损伤的深度和范围。结果　热灼后肉眼下见 :皮层呈红白相间的条纹状改变 ,与多软膜下横纤维切断术 (MST)类似。显微结构见 :热损伤仅在脑浅表皮层 (Ⅰ～Ⅲ )。随访 10 8例术后病例 1～ 5年 ,癫痫发作消失的占 75 9% ,总有效率 91 7%。术后 9例病人出现一过性的功能障碍 ,但均在一周左右恢复。结论　非功能区致痫灶切除辅助功能区致痫灶热灼 ,其疗效肯定 ,方法安全可靠 ,易在临床推广。Objective Damaging the horizontal fibres with bipolar coagulation on the functional cortexes (BCFC) to treat the intractable epilepsy, a new method had been used in our hospital, and we are trying to evaluate it's efficiency. Methods 124 patients with intractable epilepsy had been surgically treated with this new method. All patients had been detected thoroughly with intra operative electrocorticography (ECoG) before and after operations. If the epileptogenic foci were detected locating on or involving to the functional cortexes, thermo damages with BCFC were used. Pathological analysis could provide the depths and areas of the damage. Results A series of red and white strips were formed after coagulation on the surface of cortex, and the micro structure exam showed the coagulated necrosis only within superficial layers (Ⅰ～Ⅲ). The depths caused by BCFC were consistent with multiple subpial transection. 108 cases had been followed up from 1 to 5 years with the seizure free in 75.9% (82/108). The total efficiency was 91 7%. 9 cases had side effects temporally, but all recovered in a week after surgery. Conclusions Removing the epileptogenic foci combining with BCFC is a new way to treat the functional refractory epilepsy with an effective outcome. It is safe, easy to handle, and easy to spread clinically.

关 键 词：脑功能区 致痫灶 多软膜下横切术 辅助性热灼术 顽固性癫痫 

分 类 号：R742.1[医药卫生—神经病学与精神病学]