后象限离断术治疗颞顶枕叶难治性癫痫初步探讨（附三例报道）  

Posterior quadrant disconnection surgery for intractable epilepsy in temporoparietooccipital lobe： a report of three cases

作　　者：金卫篷[1] 尹绍雅[2] 李宏[1] 冯珂珂[2] 冯梅[2] 

机构地区：[1]天津医科大学第二医院神经外科,天津300211 [2]天津市环湖医院神经外科,300060

出　　处：《中华神经医学杂志》2015年第9期941-944,共4页Chinese Journal of Neuromedicine

基　　金：天津市卫生计生委科技基金（2014KG116）;天津市卫生局科技基金（2013KZ046）

摘　　要：目的初步探讨后象限离断术在颞顶枕叶难治性癫痫治疗中的作用和效果。方法回顾性分析天津市环湖医院功能神经外科自2012年2月至2013年10月采取后象限离断术治疗的3例后象限难治性癫痫患者的临床表现、神经电生理及影像学检查结果及随访情况。结果3例患者临床发作形式分别为简单部分发作、部分发作继发全面发作及全面强直阵挛发作，MRI检查显示病理改变分别为脑穿通畸形、脑白质发育不良及灰质异位。患者于全麻下行右侧后象限离断术。3例患者分别随访32、12、29个月，其中EngelⅠⅡ级2例、EngelⅡ级1例，无长期神经功能障碍或死亡病例。结论后象限离断术可获得与切除术相似的治疗效果，是治疗局限于一侧后象限的难治性癫痫的有效方法。Objective To discuss the effect of posterior quadrant disconnection surgery on temporoparietooccipital intractable epilepsy. Methods A retrospective review of clinical, neuropsychological, EEG, imaging and histopathological data of 3 patients with intractable epilepsy, admitted to and underwent posterior quadrant disconnection surgery in our hospital from February 2012 to October 2013, was performed. Results The clinical manifestations of 3 patients were simple partial seizures generalized seizures secondary to partial seizures and generalized tonic clonic seizures. MRI examination showed that 3 patients were porencephaly, white matter dysplasia, and gray matter heterotopia. Patients were treated with right posterior quadrant disconnection surgery after general anesthesia. Follow up of 32, 12 and 29 months was respectively performed in these 3 patients. The seizure control result after surgery was Engel Ⅰ in 2 patients and Engel Ⅱ in one patient. There was no new prolonged neurological deficit or death. Conclusion Posterior quadrant disconnection surgery is an effective method for posterior quadrant intractable epilepsy, which results in similar excellent early seizure control as hemispherectomy.

关 键 词：难治性癫痫 后象限离断术 颞顶 枕叶 

分 类 号：R651.1[医药卫生—外科学]