癫痫杂志

癫痫杂志

顽固性癫痫的术前评估及手术策略

查看全文

目的探讨顽固性癫痫的术前评估手段、手术治疗方法及术后疗效。方法研究纳入了 2009 年 6 月—2017 年 6 月于武汉脑科医院就诊的 125 例顽固性癫痫患者,男 85 例,女 40 例,年龄 1~70 岁,病程 1~32 年。所有患者术前均行视频脑电图(VEEG)监测和核磁共振(MRI)检查,必要时加行磁共振血波谱(MRS)分析,部分患者还行了神经心理学评估。根据 VEEG 和 MRI 的结果,在术中皮层脑电图(ECoG)监测下对患者进行手术,术后通过 1 年以上的随访来观察手术疗效。结果术后随访发现 50 例患者疗效满意,29 例显著改善,23 例效果良好,效果较差 19 例,无改善 4 例,手术总有效率为 81.6%,优良率为 41.6%。其中 80 例行致痫灶切除术患者手术有效率 81.3%,40 例行前颞叶切除术患者手术有效率 87.5%,3 例行功能性大脑半球切除术患者手术有效率 100%,1 例行功能区皮层热灼术的患者术后癫痫发作缓解 50%,1 例行迷走神经刺激术(Vagus nerve stimulation, VNS)患者术后癫痫发作缓解 50%。结论对顽固性癫痫患者行前颞叶切除、致痫灶切除和功能性大脑半球切除的疗效较好,而单纯行胼胝体切开、多处软脑膜下横纤维切断术、皮层热灼或 VNS 手术疗效相对较差,因此术前应系统评估并准确定位致痫灶,尽量采取切除性手术,以提高癫痫外科的手术疗效。

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.

关键词: 顽固性癫痫; 术前评估; 手术

Key words: Intractable epilepsy; Preoperative assessment; Surgery

引用本文: 王焕明, 胡飞, 陈俊, 熊玉波, 杨艳萍. 顽固性癫痫的术前评估及手术策略. 癫痫杂志, 2018, 4(5): 391-395. doi: 10.7507/2096-0247.20180064 复制

登录后 ,请手动点击刷新查看全文内容。 没有账号,
登录后 ,请手动点击刷新查看图表内容。 没有账号,
1. 中华医学会编著临床诊疗指南 (癫痫病分册). 北京: 人民卫生出版社: 2015: 57-58.
2. 谭启富. 癫痫外科的治疗现状. 中华神经外科杂志, 1999, 15(6): 331-332.
3. 谭启富. 我国癫痫外科发展之管见. 中国临床神经外科杂志, 2006, 11(8): 449.
4. 谭启富, 胡志刚. 再论癫痫手术疗效评价问题. 中国现代神经疾病杂志, 2009, 9(4): 323-326.
5. Nowell M, Miserocchi A, McEvoy AW, et al. Advances in epilepsy surgery. J Neurol Neurosurg Psychiatry, 2014, 85(11): 1273-1279.
6. Engel L. Surgical treatment of the epilepsies. 2nd Edition. New York: Raven Press, 1993: 23-25.
7. Spencer SS, Spencer DD. Surgery for epilepsy. Boston. Blackwell Scientific, 1991: 50-55.
8. Wyler AR, Wilkus AT, Rostad SW, et al. Multiple subpial transection for partial seizures in sensorimotor cortex. Neurosurgery, 1995, 37(6): 112-118.
9. Smith MC. Multiple subpial transection in patients with extratemporal epilepsy. Epilepsia, 1998, 39(Suppl 4): 81-89.
10. Hufnagel A, Zentuer T, Fernandez G, et al. Multiple subpial transection for control of epileptic seizures: effectiveness and safety. Epilepsia, 1997, 38(6): 678-683.
11. 栾国明, 李云林, 闫丽, 等. 痫灶切除辅助性脑皮层横行纤维热灼治疗功能区癫痫的临床研究. 中华神经外科杂志, 2002, 18(4): 209-212.
12. Wheless JW, Gienapp AJ, Ryvlin P. Vagus nerve stimulation (VNS) therapy update. Epilepsy Behav, 2018: pii: S1525-5050.
13. 田宏, 凌至培, 常鹏飞, 等. 胼胝体切开联合皮层热灼术治疗难治性癫痫. 立体定向和功能性神经外科杂志, 2007, 20(4): 193-195.
14. 王焕明, 胡飞, 陈俊, 等. 迷走神经刺激手术治疗顽固性癫痫. 癫痫杂志, 2017, 3(5): 452-454.