【摘要】 目的 探讨顽固性癫痫外科术前与术中癫痫病灶定位的异同及手术方式的选择。 方法 2002年7月-2009年10月收治复杂、部分发作的顽固性癫痫78例。术前癫痫病灶定位主要采用头MRI及24 h视频脑电图检查，癫痫病灶局限于颞叶31例，颞叶、额叶47例。术中行24导皮层脑电图监测进一步定位癫痫病灶，并在其指导下联合多种癫痫术式完成手术。 结果 术前视频脑电图检查定位癫痫病灶与术中皮层脑电图监测定位具有高度一致性，但后者定位范围较前者有扩大。 结论 术中皮层脑电图监测证实并进一步精确定位癫痫病灶范围，以及在指导手术切除癫痫病灶范围，癫痫术式选择方面具有重要意义。【Abstract】 Objective To evaluate the preoperative and intraoperative epileptogenic focus location variation, and indication of surgical options for elevating outcome of refractory epilepsy patitents. Methods All of 78 refractory epilepsy patitents were complex partial seizure. Magnetic resonance imaging and 24 hour video electroencephalogram (VEEG) were used to orientate epileptogenic focus preoperatively. Thirty-one patiens were limited to temporal and forty-seven patients were both temporal and frontal. Twenty-four lead electrocorticogram (ECoG) was used to orientate epileptogenic focus intraoperatively and directed multiple operative patterns. Results Thereisa certain coherence between Preoperative VEEG and intraoperative ECoG epileptogenic focus location, but larger rangein latter. Conclusion Intraoperative e ECoG may orientate epileptogenic focus further accurately, for the suitable surgical options and appropriate surgical excision.