半球性病变癫痫外科术式选择策略  

Strategy of operation ways selection for hemispheric epilepsy

作　　者：林久銮[1] 周文静[1] 孙朝晖[1] 王海祥[1] 宋宪成[1] 张冰清[1] 张玉琪[1] 左焕琮[1] 

机构地区：[1]清华大学玉泉医院癫痫中心,100049

出　　处：《临床神经外科杂志》2015年第3期163-167,共5页Journal of Clinical Neurosurgery

基　　金：国家重点基础研究发展计划(973)(2012CB720704)

摘　　要：目的研究半球性病变癫痫不同手术方式选择的策略。方法回顾分析清华大学玉泉医院癫痫中心90例半球性病变（包括Rasmussen脑炎、巨脑回、围产期脑出血后遗症、脑炎后遗症、血管闭塞后遗症、脑面血管瘤）病种、范围、部位,癫痫采用的手术方式及决定或影响手术方式的因素。结果 90例共采用4种手术方式,其中74例采用改良解剖大脑半球切除、10例采用保留运动区的大脑半球切除、3例采用分次的半球切除、3例采用半球离断。其中改良的解剖大脑半球切除中有62例采用经纵裂胼胝体侧脑室入路切除方式、12例采用经中央沟侧脑室前后分块切除。病例随访3个月-8年,癫痫控制情况根据Engle评分,Ⅰ级73例、Ⅱ级12例;Ⅲ级5例。结论综合考量磁共振病变特点、症状学及脑电图定侧定位和脑功能评价结果,采用不同的手术方式,能够取得很好的癫痫控制效果、最大程度的保护脑功能、减少创伤、降低术后并发症。Objective To study the different ways of operation for hemispheric epilepsy . Methods The different operation ways and procedure of the 90 patients who underwent hemispherectomy for refractory epilepsy were analyzed in the retrospective study .Results Among the 90 patients, 4 operation ways were selected , the modified hemispherectomy were used for 74 patients, the hemisphrectomy with motor cortex preserved were used in 10,the hemisphrectomy by two stages were used in 3 , and the hemisphretomy only were used in 3 .The modified hemispherectomy were performed via longitudinal fissure callosal and ventricle approach in 62 patients,and were performed by two block removal via central sulcus ventricle approach in 12 patinets.Of 90 patients who were followed up from 3 months to 8 years,73 belonged in Ⅰ, 12 in grade Ⅱand 5 in grade Ⅲaccording Engel ’ s classification .Conclusion The selection of suitable ways of the operation account of the features of the lesion , the EEG , the symptoms and brain functions for hemispheric epilepsy is important for inhanceing the effect of seizure controls and lowing the operation complications .

关 键 词：癫痫 大脑半球切除术 手术方式 

分 类 号：R742.1[医药卫生—神经病学与精神病学]