【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.
ObjectiveTo explore the strategy and outcome of surgery for the treatment of encephalomalacia with secondary intractable epilepsy. MethodsDuring the period of July 2009 and June 2015, 21 cases of encephalomalacia with secondary intractable epilepsy were performed operation. Among them there were 16 males and 5 females. Their ages ranged from 4 to 34 years, with their illness duration from 3 to 14 years. According to the results of MRI and video-EEG monitoring, all the patients were performed operation under the monitoring of ECoG. And the outcome was graded by Engle scales for analysis. ResultsECoG monitoring after the resection of encephalomalacia showed that there was still abnormal discharge. Enlarged cortical resection was performed in 10 cases, and cortical coagulation in 3、anterior temporal lobectomy + resection of the hippocampus and amygdala in 4、additional callosotomy in 4. The post-operative follow-up of 1~7 years showed that Grade Ⅰ was observed in 10 cases、Grade Ⅱ in 5 cases、Grade Ⅲ in 3 cases and Grade Ⅳ in 3 cases.The total surgical effectiveness was 85.7%. ConclusionTo the patients of encephalomalacia with secondary intractable epilepsy, the epileptic lesion should be resected besides the resection of encephalomalacia. And the surgical effectiveness is satisfactory.
ObjectivesTo explore the preoperative assessment method, operative approach and post-operative effect of intractable epilepsy.MethodsOne hundred and twenty five intractable epilepsy patients (85 males and 40 females) from Wuhan Brain Hospital during June 2009 to June 2017 were collected in this study. Their age ranged from 1 to 70 years old, with disease course of 1 ~ 32 years. All the patients underwent VEEG monitoring and MRI examination before operation, and MRS was performed when necessary. Some patients also received psychological assessment. According to the result of VEEG and MRI results, all the patients underwent operations under ECoG monitoring . The surgery effect was followed-up for more than 1 year.ResultsThe post-operative follow-up showed that satisfactory result was achieved in 50 cases, remarkable improvement in 29 cases, good effect in 23 cases, bad effect in 19 cases, and no improvement in 4 cases. The total effective rate of epilepsy surgery was 81.6%, and excellent rate was 41.6%. The effective rate was 81.3% in 80 cases of epileptogenic focus epileptic lesion resection, 87.5% in 40 cases of anterior temporal lobectomy (ATL), and 100% in 3 cases of functional hemispherectomy was, and good effect in the cases of pure cortical coagulation and VNS.ConclusionsThe surgical effects of ATL, epileptogenic focus resection and functional hemispherectomy are better than that of pure corpus callosotomy, multiple subpial transaction (MST), multiple subdural transversely fibrinectomy, VNS or cortical coagulation. So epileptogenic focus should be accurately located preoperatively, and it is better to choose resection operation in order to increase the surgical effect of intractable epilepsy.