外伤后癫痫的外科治疗（附14例报告）  

Surgical treatment of post-traumatic epilepsy： a retrospective analysis of 14 cases

作　　者：刘智良[1] 丁虎[1] 尹鹏[1] 刘建明[1] 孟繁鑫[1] 游宇[1] 王艳[1] 温静[1] 徐如祥[1] 

机构地区：[1]北京军区总医院附属八一脑科医院,北京100700

出　　处：《中华神经医学杂志》2015年第7期715-719,共5页Chinese Journal of Neuromedicine

基　　金：国家自然科学基金（81301116）

摘　　要：目的探讨外伤后癫痫的手术治疗方法和效果。方法回顾性分析北京军区总医院附属八一脑科医院自2010年11月至2013年7月接受外科手术治疗的14例难治性外伤后癫痫患者临床资料。所有患者均经严格的术前评估，其中5例病灶毗邻重要功能区者分别采用颅内电极植入（4例）和术中神经功能导航（5例）；随后分别行皮层电刺激和功能磁共振导航完成脑功能区精确定位及致痫灶与运动区的位置关系确定。手术切除所有患者癫痫病灶，术后定期进行随访并采用Engle分级进行疗效评定。结果所有患者均成功实施了癫痫病灶切除术。颅内电极植入的患者经功能磁共振导航和皮层电刺激双重定位，毗邻功能区的癫痫病灶达到精准切除，同时患者运动功能得到良好保护。术后随访12～30个月，EngleⅠ级7例、Ⅱ级5例、Ⅲ级2例，未出现永久性神经功能障碍。结论对于药物难治性外伤后癫痫，精确定位癫痫病灶和脑功能区后可以经外科切除术获得良好疗效。Objective To investigate the surgical procedures and clinical effects of refractory post-traumatic epilepsy. Methods Fourteen patients with refractory post-traumatic epilepsy, underwent surgical treatment in our hospital from November 2010 to July 2013, were involved in present study. All patients underwent strict preoperative evaluation. Before the operation, symptomatology, brain electrophysiology, MR imaging were performed successively. And, 5 epilepsy patients with epileptic foci adjacent to motor or language function areas underwent intracranial electrode implantation （n=4） or intraoperatie neurologic navigation （n=5）, subsequently underwent cortical stimulation mapping （CSM） and functional MRI （fMRI）, respectively, to locate the epileptic foci and important brain regions for guiding epilepsy resection surgery. Then, all patients underwent epileptic foci resection. After the operation, the regular clinical and iconography follow-up were in progress. Results The traumatic lesions were successfully excised, and the motor area, language function, pyramidal tracts and arcuate fascicle were protected effectively. During the follow-up of 12-30 months, 7 patients were found to be completely seizure-free or with only aura （Engel Ⅰ）, 5 patients had only rare seizure （Engel Ⅱ, fewer than three seizures per year）, and 2 patients had significantly reduced seizure （Engel Ⅲ）. Meanwhile the motor and language functions of the patients got good protection guided by fMRI and CSM. Conclusion By means of accurate location of the epileptic foci and brain functional area, patients with refractory traumatic epilepsy underwent surgical treatment can achieve satisfactory clinical outcome.

关 键 词：癫痫 外科手术 功能磁共振 皮层电刺激 

分 类 号：R651.1[医药卫生—外科学]