CAJ | 학술논문

目的探讨功能性大脑半球切除术治疗顽固性癫痫伴有偏瘫患者的效果.方法自2002年4月至2007年12月,笔者协助6家兄弟医院采用功能性大脑球切除术治疗8例癫痫伴有一侧半球萎缩患者.8例均经头皮脑电图和视频脑电图检查,7例病侧半球有痈波,另1例对侧(正常侧)半球有痫波.脑MRI检查均显示一侧半球广泛性萎缩改变,脑室扩大显著.在吸取Schramm等改良的功能性大脑半球切除技术基础上,采用Rasmussen的方法进行手术.结果随访期8个月至6.4年,平均2.8年.术后癫痫控制结果采用国内术后结果评估方案评估:满意(癫痫发作完全消失)7例,但其中1例术后癫痫完全消失2年,后因自行停药,癫痫再发,经改用2种抗痈药后至今未发作;显著改善(癫痫发作减少70%)1例.术后抗痫药剂量、种类与术前相比有减少者6例,术后停药者2例.本组无死亡及严重的并发症,仅1例在同手术期发生急性癫痫持续状态,经抢救治愈.术后脑电图病侧半球6例无痫波,对侧半球(非手术侧)有痫波者2例.偏瘫情况:7例偏瘫不加重,其中6例瘫痪肢体功能有恢复,但拇指功能大多无改善;1例术后暂时性肌力下降,术后逐渐恢复并有好转.一般生活状态表现为术后性格变得温顺合作,已能上学4例,家务劳动2例,休息2例.结论功能性大脑半球切除术治疗顽同性癫痫伴一侧半球病损的患者效果满意,且该手术并发症发生率低,值得推广应用.
목적 탐토공능성대뇌반구절제술치료완고성전간반유편탄환자적효과.방법 자2002년4월지2007년12월,필자협조6가형제의원채용공능성대뇌구절제술치료8례전간반유일측반구위축환자.8례균경두피뇌전도화시빈뇌전도검사,7례병측반구유옹파,령1례대측(정상측)반구유간파.뇌MRI검사균현시일측반구엄범성위축개변,뇌실확대현저.재흡취Schramm등개량적공능성대뇌반구절제기술기출상,채용Rasmussen적방법진행수술.결과 수방기8개월지6.4년,평균2.8년.술후전간공제결과채용국내술후결과평고방안평고:만의(전간발작완전소실)7례,단기중1례술후전간완전소실2년,후인자행정약,전간재발,경개용2충항옹약후지금미발작;현저개선(전간발작감소70%)1례.술후항간약제량、충류여술전상비유감소자6례,술후정약자2례.본조무사망급엄중적병발증,부1례재동수술기발생급성전간지속상태,경창구치유.술후뇌전도병측반구6례무간파,대측반구(비수술측)유간파자2례.편탄정황:7례편탄불가중,기중6례탄탄지체공능유회복,단무지공능대다무개선;1례술후잠시성기력하강,술후축점회복병유호전.일반생활상태표현위술후성격변득온순합작,이능상학4례,가무노동2례,휴식2례.결론 공능성대뇌반구절제술치료완동성전간반일측반구병손적환자효과만의,차해수술병발증발생솔저,치득추엄응용.
Objective To investigate the effect of functional hemispherectomy on intractable epilepsy with hemiparalysis. Methods From April 2002 to December 2007, 8 epileptic patients with hemisphere atrophy received functional hemispherectomy in 6 hospitals. Scalp and video EEG examinations revealed epileptic waves in all the patients, including 7 in the ipsilateral side and 1 in the contralateral side. Magnetic resonance imaging (MRI) indicated hemisphere atrophy and ventriculomegaly in all the patients. Risk factors for epilepsy were found in all the patients, including 3 with hyperpyrexia, 2 with spontaneous intracranial hemorrhage, 2 with traumatic brain injury, and 1 with viral encephalitis (also suspected of Rasmussen's encephalitis). Hemispberectomy was performed based on the methods of Rasmussen and Schramm. Results All the patients were followed up postoperatively for 8 months to 6.4 years (mean 2.8 years). Satisfactory outcomes (including disappearance of seizures) were achieved in 6 patients, but 1 of them experienced seizure reoccurrence because of personal withdraw of antiepileptic drugs 2 years after total seizure relief, and was successfully managed by administration of another two antiepileptic drugs. Significant improvement was achieved in the other case, in which the seizure frequency was reduced by over 70%. The postoperative dose or number of the antiepileptic drugs was reduced in 6 patients, and 2 patients no longer required any medication. No death or serious complications occurred in these patients except for 1 patient who suffered acute status epilepticns perioperatively and was successfully managed. Postoperative EEG revealed the absence of epileptic waves in 6 patients. Two patients showed epileptic waves on the contralateral side. Paralysis aggravation was not observed in 7 patients, and 1 patient experienced temporal muscle weakness, which recovered gradually. Six patients showed improved limb functions, but the thumb function failed to recover. The patients became gentle and cooperative after the operation, and 4 were able to receive formal education. Two patients were capable of carrying out housework, and 2 stayed at home. Conclusion Functional hemispherectomy is effective for management of intractable epilepsy with paralysis and causes low rate of complications.