中央区癫的外科治疗策略  

Surgical strategy of perirolandic epilepsy

作　　者：余佳彬[1] 谢海涛[2] 谢学敏[2] 伍犹梁[2] 韩富[2] 隋立森[2] Yu Jiabin Xie Haitao Xie Xuemin Wu Youliang Han FU Sui Lisen(Graduate School of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510405, China Epilepsy Center, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, Guangdong 510120, China)

机构地区：[1]广州中医药大学研究生院,510405 [2]广东省中医院癫痫中心,广州510120

出　　处：《中国微侵袭神经外科杂志》2017年第5期205-208,共4页Chinese Journal of Minimally Invasive Neurosurgery

基　　金：国家自然科学基金资助项目(编号:81171179);广东省科技厅科技项目[编号:粤科规划字(2013)137号]

摘　　要：目的探讨累及中央区癫的外科治疗方法。方法回顾性分析21例中央区癫病人的临床资料。术前行常规评估检查及神经功能评分。根据情况分别采用立体脑电描记(SEEG)、唤醒麻醉、神经导航、术中电生理监测、皮质直接电刺激等技术定位致灶及功能区,然后完成致灶切除。结果肿瘤继发癫18例:肿瘤+致灶全切12例,肿瘤全切+致灶热灼3例,仅切除肿瘤1例,肿瘤不完全切除+致灶热灼2例。局灶性皮质发育不良病例3例,SEEG定位后手术切除致灶。术后3个月,6例出现短暂神经功能障碍,2例永久性障碍。术后随访6~44个月,Engel分级:Ⅰ级15例,Ⅱ级3例,Ⅲ级2例,Ⅳ级1例。结论多技术联合运用于中央区癫手术,可提高致灶切除率和降低病残率,癫控制效果良好。Objective To explore the surgical strategy of epilepsy involving in perirolandic area （EIPA）. Methods Clinical data of 21 EIPA patients treated by surgery were analyzed retrospectively. All the patients were assigned to receive routine evaluative tests and neurological function score before surgery. Stereoelectroencephalography （SEEG）, awake anesthesia, neuronavigation, intraoperative EEG monitoring, direct cortical electrical stimulation were used to locate the epileptogenic focus and functional area according the individual situation. Then the epileptogenic focus was resected according to location results. Results There were 18 patients with epilepsy secondary to tumors. Total resection of tumor and epileptogenic focus were achieved in 12 patients, total resection of the tumor and electrocoagulation of epileptogenic focus were achieved in 3, simple total resection of the tumor was in 1, subtotal resection of the tumor and electrocoagulation of epileptogenic focus were in 2. The focal cortical dysplasia was found in 3 patients and the epileptogenic focus was located by SEEG and resected. The transient dysneuria was seen in 6 patients and permanent dysneuria in 2 ones 3 months after surgery. All the patients were followed up for 6 to 44 months. Engel class Ⅰ was acieved in 15 patients, class Ⅱ in 3, class Ⅲ in 2 and class Ⅳ in 1. Conclusions Multiple technologies combined with surgery in EIPA can increase the resection rate of epileptogenic focus, decrease the disability rate and achieve good outcome.

关 键 词：癫 功能区 致灶 肿瘤 颅内 皮质发育不良 局灶性 

分 类 号：R651.1[医药卫生—外科学]