岛周半球离断术治疗儿童药物难治性癫痫二例  

Peri-insular hemispherotomy in paediatric intractable epilepsy

作　　者：宋云海 顾硕[1] 栾国明[2] 鲍南[1] 杨波[1] 叶晓来[3] 范家俊 俞宏真[3] 顾颉[3] 王翠锦 

机构地区：[1]上海交通大学医学院附属上海儿童医学中心神经外科,上海200127 [2]首都医科大学三博脑科医院神经外科 [3]上海交通大学医学院附属上海儿童医学中心神经内科,上海200127

出　　处：《脑与神经疾病杂志》2016年第12期747-751,共5页Journal of Brain and Nervous Diseases

摘　　要：目的通过2例儿童药物难治性癫痫患者探讨儿童岛周半球离断术(PIH)的适应证、操作技术、手术效果。方法病例1为11岁男孩,诊断为药物难治性癫痫。临床表现为简单部分性发作,发作频繁。MRI示左侧大脑半球弥漫性软化灶,24h视频脑电图(24h-VEEG)示双侧中央、中线区为主大量痫性放电,左侧显著,可泛化。病例2为4岁男孩,诊断为创伤后药物难治性癫痫,临床表现为发作性跌倒。MRI示左侧颞叶软化灶,左侧半球萎缩,24h-VEEG显示左侧半球大量痫性放电。两例患儿都经过充分的术前评估和术前准备,行PIH,手术过程顺利。结果本文2例恢复良好,右侧肢体运动功能无明显下降,言语功能无明显影响。术后分别随访36个月、24个月未再有癫痫发作,疗效评估Engel I级,神经心理学评估显示智力有所提高。结论 PIH是功能性大脑半球切除术中的一种优化方法,对于儿童来说具有和大脑半球切除术相同的疗效,手术创伤相对较小,没有出现明显的并发症。Objective To report two cases of refractory epilepsy treated by peri-insular hemispherotomy, investigate indications, technique, results of operations and review of the relevant literature. Method Case 1 is a 11-year-old boy, diagnosed with drug-refractory epilepsy. Clinical manifestations of simple partial seizures, onset frequently. MRI display left hemisphere diffuse malacia, 24h-VEEG showed bilateral central area a lot of epileptic discharge, left remarkable. Case 2 was a 4-year-old boy, diagnosed as post-traumatic drug-refractory epilepsy, clinical manifestations of the onset of fall.MRI display malacia left temporal lobe, the left hemisphere atrophy, 24h-VEEG showed a lot of epileptic discharge from left hemisphere. Two children have been sufficient preoperative assessment and preoperative preparation, performed peri-insular hemispherotomy, surgery went smoothly. Results 2 children have recovered well after operation, right limb was no significant decline in motor function, speech function was not significantly affected. Are followed up after 36 months, 24 months had no seizures, efficacy evaluation Engel class I, neuropsychological assessment showed intelligence increased. Conclusion peri-insular hemispherotomy is a optimization method of functional hemispherectomy for children, have the same effect with hemispherectomy, surgical damage is smaller, there was no significant complications.

关 键 词：儿童 岛周半球离断术 大脑半球切除术 癫痫 手术 

分 类 号：R742.1[医药卫生—神经病学与精神病学]