创伤性癫痫的临床特征及外科治疗  

Clinical features and surgical treatment of posttraumatic epilepsy

作　　者：漆松涛[1] 邱炳辉[1] 欧阳辉[1] 彭玉平[1] 

机构地区：[1]第一军医大学南方医院神经外科,广东广州510515

出　　处：《第一军医大学学报》2004年第4期472-474,共3页Journal of First Military Medical University

摘　　要：目的探讨创伤性癫痫的临床特征、外科治疗方法的选择及其效果。方法对35例创伤性癫痫病人进行电生理学、CT、MRI、SPECT及PET检查后行外科治疗,开颅手术病例术中行皮层脑电监测。结果在皮层脑电监测下16例行癫痫病灶切除、7例行多处软脑膜下横纤维切断术,12例在PET引导下行立体定向放射外科治疗,癫痫灶大都位于脑软化灶周边。术后得到随访32例(时间1至4年),18例无癫痫发作,10例明显好转,4例无改善。结论创伤性癫痫发作会加重原创伤引起的神经功能障碍,外科治疗均能取得良好效果并可减轻药物的毒副作用。近年来采用PET引导下的立体定向放射外科治疗具有无创、有效的特点,是一个非常有前景的创伤性癫痫外科新方法。Objective To study the clinical features of posttraumatic epilepsy and evaluate the surgical procedures for anti-epileptic treatment and their therapeutic effects. Methods Neurological and scalp EEGs were performed in 35 patients with posttraumatic epilepsy, who also underwent CT, MRI examination, single photon emission computerized tomography (SPECT) and positron emission tomography (PET) prior to intracranial surgery, with intraoperative monitoring of the cortical EEG. Results With the cortical EEG monitoring, 16 patients underwent surgical resection of the epileptogenic foci identified by intraoperative EEG, 7 had multiple subpial transection and 12 received stereotactic radiosurgery for the epileptogenic foci localized by PET. In most of the cases, the epileptogenic foci were located around the lesions of encephalomalacia. During the follow-up of 32 patients varying from 1 to 4 years, 18 patients became seizure free, 10 had obvious reduction in the frequency of seizure while 4 failed to respond favorably to the treatment. Conclusions Seizures of posttraumatic epilepsy may aggravate the brain dysfunction due to primary trauma, and surgical treatment often yields good effect and lessens the toxic and adverse effect of antiepileptic drugs. Stereotactic radiosurgery guided by PET is safe and effective in the treatment of patients with posttraumatic epilepsy.

关 键 词：创伤性癫痫 临床特征 治疗 外科手术 

分 类 号：R651.1[医药卫生—外科学]