手术治疗癫痫的适应证和并发症  

Surgical treatment for epilepsy: Indications and complications (Fren)

作　　者：Gu'enot Serv. Neurochirurg. Stereotax. F. enot M. M. Gu'H.opital P. Wertheimer 张玉龙 

机构地区：[1]59, Bd Pinel, 69003 Lyon, France

出　　处：《世界核心医学期刊文摘（神经病学分册）》2005年第2期58-59,共2页Digest of the World Core Medical Journals:Clinical Neurology

摘　　要：To be considered for resective (curative) surgery, most seizures have to been proved to arise exclusively from one area of the brain that is functionally sile nt. The drug resistance must be certain, and the patient must be strongly motiv ated to undergo surgery. Temporal lobectomy for drug resistant temporo me sia l epilepsy is now scientifically validated by a randomized controled trial. Hemi spherotomy, which consists in complete disconnection of one hemisphere, is a cur ative technique, which may be considered where there is a pre existing hemipleg iaassociated with a structural abnormality of the contralateral hemisphere. Ther efore, it is rarely performed in adult patients. Stereotactic radiosurgery is al so a curative technique, which shares most of its indications with those of temp oro mesial re sections. Callosotomy is a palliative technique, which consists in disconnecting the hemispheres, one from the other. It may be considered in in dividuals having frequent atonic seizures (drop attacks). Multiple subpial trans ection involves transection of transverse fibers, leaving longitudinal fibers in tact. It may be performed if the epileptogenic focus is located in an eloquent b rain area. The complication rate of resective surgery is low. Controlateral moto r impairement is the main permanent complication related to cortical resection. It is a rare occurence (1 to 2 percent of cases) due to peroperative lesions of the sylvian vasculature, or of the anterior choroidal artery, or even of the mot or area. Postoperative hematomas, infections, or hydrocephalus may also occur in 2 to 6 percent of cases, depending on the authors. Some postoperative neuropsyc hological complications are reported in the literature, especially after surgery on the dominant side. Hydrocephalus and infection are the most frequent complic ations occuring after hemispherotomy (10 percent of cases). Dysconnexion syndrom is a rare complication, which can be seen after total callosotomy. It is unusua l for the effects of disconnection afteTo be considered for resective (curative) surgery, most seizures have to been proved to arise exclusively from one area of the brain that is functionally sile nt. The drug resistance must be certain, and the patient must be strongly motiv ated to undergo surgery. Temporal lobectomy for drug resistant temporo me sia l epilepsy is now scientifically validated by a randomized controled trial. Hemi spherotomy, which consists in complete disconnection of one hemisphere, is a cur ative technique, which may be considered where there is a pre existing hemipleg iaassociated with a structural abnormality of the contralateral hemisphere. Ther efore, it is rarely performed in adult patients. Stereotactic radiosurgery is al so a curative technique, which shares most of its indications with those of temp oro mesial re sections. Callosotomy is a palliative technique, which consists in disconnecting the hemispheres, one from the other. It may be considered in in dividuals having frequent atonic seizures (drop attacks). Multiple subpial trans ection involves transection of transverse fibers, leaving longitudinal fibers in tact. It may be performed if the epileptogenic focus is located in an eloquent b rain area. The complication rate of resective surgery is low. Controlateral moto r impairement is the main permanent complication related to cortical resection. It is a rare occurence (1 to 2 percent of cases) due to peroperative lesions of the sylvian vasculature, or of the anterior choroidal artery, or even of the mot or area. Postoperative hematomas, infections, or hydrocephalus may also occur in 2 to 6 percent of cases, depending on the authors. Some postoperative neuropsyc hological complications are reported in the literature, especially after surgery on the dominant side. Hydrocephalus and infection are the most frequent complic ations occuring after hemispherotomy (10 percent of cases). Dysconnexion syndrom is a rare complication, which can be seen after total callosotomy. It is unusua l for the effects of disconnection afte

关 键 词：半球切除术 大脑半球 胼胝体切开 软膜 术后神经功能 癫痫病灶 频发性 优势半球 随机对照试验 脉络膜前动脉 

分 类 号：R742.1[医药卫生—神经病学与精神病学]