致痫灶切除术治疗辅助运动区癫痫的初步观察  

Preliminary observation of epileptogenic zonectomy in the treatment of epilepsy arising from supplementary motor area

作　　者：倪端宇[1] 王雪原[1] 乔梁[1] 闫浩 遇涛[1] 徐翠萍[1] 朴媛媛[1] 何柳[1] 张国君[1] 张晓华[1] Ni Duanyu;Wang Xueyuan;Qiao Liang;Yan Hao;Yu Tao;Xu Cuiping;Piao Yuanyuan;He Liu;Zhang Guojun;Zhang Xiaohua(Department of Functional Neurosurgery,Xuanwu Hospital of Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院功能神经外科,北京100053

出　　处：《中华神经外科杂志》2022年第5期471-475,共5页Chinese Journal of Neurosurgery

基　　金：北京市医院管理局"登峰"人才培养计划(DFL20190801)。

摘　　要：目的初步观察致痫灶切除术治疗辅助运动区(SMA)癫痫的疗效及术后并发症。方法回顾性分析2015年6月至2020年12月首都医科大学宣武医院功能神经外科收治的9例SMA癫痫患者的临床资料。9例患者均经立体脑电图证实发作起源于SMA,且行致痫灶切除术。所有患者分别于术后住院期间每日进行肢体肌力、肌张力和语言功能(理解、阅读、复述等)的检查。术后1、3、6、12及24个月对患者进行门诊随访,行脑电图检查,根据改良Engel分级标准评估术后疗效。结果9例患者中,5例行左侧致痫灶切除术,4例行右侧致痫灶切除术,切除范围均包含同侧SMA。术后病理学结果均为局灶性皮质发育不良。术后8例患者癫痫发作完全消失,1例偶有愣神;9例患者均有不同程度的肢体活动障碍,术后1个月均恢复至正常;4例出现语言功能障碍,其中1例于术后7 d恢复,3例于术后1个月恢复正常。9例患者的中位随访时间为3年(1~5年)。至末次随访,改良Engel分级Ⅰa级8例,Ⅰb级1例。结论初步观察发现,采用致痫灶切除术治疗癫痫起源于SMA的患者,远期疗效好,虽然术后常出现SMA综合征,但均在术后1个月内恢复。Objective To preliminarily observe the efficacy and postoperative complications of epileptogenic zonectomy in the treatment of epilepsy arising from supplementary motor area(SMA).Methods A retrospective analysis was conducted on the clinical data of 9 patients with SMA epilepsy admitted to the Department of Functional Neurosurgery,Xuanwu Hospital of Capital Medical University from June 2015 to December 2020.In all 9 patients,their seizures were confirmed by stereotactic electroencephalography(SEEG)to originate from SMA,and they underwent epileptogenic zonectomy.All patients underwent daily examinations of limb muscle strength,muscle tone and language function(comprehension,reading,repetition,etc.)during the postoperative hospital stay.Outpatient follow-up was performed at 1,3,6,12 and 24 months after operation,and electroencephalography was performed.The postoperative outcome was evaluated according to the modified Engel grading system.Results Among the 9 patients,5 underwent epileptogenic zonectomy in the left hemisphere and 4 in the right hemisphere.The resected area included ipsilateral SMA.Postoperative pathological examination revealed focal cortical dysplasia in all cases.After operation,8 patients reached seizure free,and 1 patient reported occasional short periods of loss of consciousness.Nine patients had different degrees of limb movement impairment,and all returned to normal one month after surgery.Four patients had language dysfunction,out of whom 1 patient recovered 7 days after surgery and 3 returned to normal 1 month after operation.The median follow-up time of 9 patients was 3 years(1-5 years).At the last follow-up,8 cases were classified asⅠa and 1 case asⅠb according to the modified Engel grading system.Conclusion Preliminary observation has suggested that epileptogenic zonectomy for patients with epilepsy originating from SMA has good long-term efficacy.Although SMA syndrome often occurs after surgery,patients would recover within 1 month after surgery.

关 键 词：癫痫 神经外科手术 治疗结果 辅助运动区 

分 类 号：R651.1[医药卫生—外科学]