CAJ | 학술논문

目的探讨脑功能评估在半球病灶性癫痫手术中的应用价值.方法回顾性分析30例半球病灶性癫痫手术患者的临床资料,其中男21例,女9例,年龄4个月～ 30岁,平均(12.9±8.7)岁,病程1个月～ 29年,平均7.8年,使用1～4种抗癫痫药物仍不能有效控制癫痫发作.术前应用MRI结合头皮视频脑电图评估致痫半球,应用利手判断、手精细运动、fMRI、DTI和Wada试验评估患侧半球脑功能,对于半球不存在脑功能者实施大脑半球切除术,而存在脑功能者,则在术中电刺激定位脑功能区前提下,实施保留脑功能区的联合手术.结果 20例(20/30)实施大脑半球切除术,10例(10/30)行保留脑功能区的联合手术.术后随访神经功能,语言功能14例(14/30)改善,无一例变差;对侧下肢运动9例(9/30)改善,无一例变差;对侧上肢粗大运动10例(10/30)改善,无一例变差;对侧手精细运动7例(7/30)改善,3例(3/30)变差(均为大脑半球切除术).对随访超过6个月的26例患者评估癫痫控制率,24例(24/30)满意,1例(1/30)显著改善,1例(1/30)良好;其中18例大脑半球切除术者,18例均满意,8例联合手术者,6例满意,1例显著改善,1例良好.结论对于半球病灶性癫痫,手术方式与术后癫痫控制率、神经功能障碍发生率关系密切,而脑功能评估对于手术方式的选择至关重要.
목적 탐토뇌공능평고재반구병조성전간수술중적응용개치.방법 회고성분석30례반구병조성전간수술환자적림상자료,기중남21례,녀9례,년령4개월～ 30세,평균(12.9±8.7)세,병정1개월～ 29년,평균7.8년,사용1～4충항전간약물잉불능유효공제전간발작.술전응용MRI결합두피시빈뇌전도평고치간반구,응용리수판단、수정세운동、fMRI、DTI화Wada시험평고환측반구뇌공능,대우반구불존재뇌공능자실시대뇌반구절제술,이존재뇌공능자,칙재술중전자격정위뇌공능구전제하,실시보류뇌공능구적연합수술.결과 20례(20/30)실시대뇌반구절제술,10례(10/30)행보류뇌공능구적연합수술.술후수방신경공능,어언공능14례(14/30)개선,무일례변차;대측하지운동9례(9/30)개선,무일례변차;대측상지조대운동10례(10/30)개선,무일례변차;대측수정세운동7례(7/30)개선,3례(3/30)변차(균위대뇌반구절제술).대수방초과6개월적26례환자평고전간공제솔,24례(24/30)만의,1례(1/30)현저개선,1례(1/30)량호;기중18례대뇌반구절제술자,18례균만의,8례연합수술자,6례만의,1례현저개선,1례량호.결론 대우반구병조성전간,수술방식여술후전간공제솔、신경공능장애발생솔관계밀절,이뇌공능평고대우수술방식적선택지관중요.
Objective To explore the application of brain mapping in the surgical management of hemisphere lesion induced epilepsy.Methods A retrospective analysis of 30 patients with hemisphere lesion induced epilepsy were enrolled,including 21 males and 9 females,whose average age was 12.9 ± 8.7 years (range from 4 months to 30 years) with the average disease duration of 7.8 years (range from 1 month ～ 29 years).The seizures were unable to be controlled by using up to four antiepileptic drugs.Preoperatively we conducted scalp video-EEG (sVEEG) and MRI examination to confirm the epileptogenichemisphere,and the function of epileptogenic hemisphere was evaluated by the handedness assessment,hand fine motor,fMRI,DTI and Wada test.Hemispherectomy was performed for patients with a nonfunctioning hemisphere.For the patients with hemisphere remained partially functional,we performed combined surgery preserved eloquent brain region,identified by intraoperative electrical stimulations.Results 20 cases (20/30) underwent hemispherectomy,and 10 cases (10/30) underwent combined surgery with reserving eloquent brain regions.Postoperative follow-up analysis showed 14 cases (14/30) achieved improvement in language function,and 9 cases(9/30) achieved improvement in motor function of contralateral lower extremity and 10 cases (10/30) achieved improvement in gross motor function of contralateral upper extremity.None of them became worse after surgery.Meanwhile,there were 7 cases (7/30) who achieved improvement in contralateral hand fine motor,while 3 case (3/30)who underwent hemispherectomy became worse after surgery.Twenty-six cases were followed up more than six months,and the control rate of epilepsy was assessed.Among them,24 cases (24/30) were satisfied with results,1 case (1/30) was significantly improved and 1 case (1/30) was beneficial; All of 18 cases who underwent hemispherectomy were satisfied,while among the other 8 cases underwent combined surgery,6 cases were satisfied,1 case was significantly improved and 1 case was beneficial.Conclusions For patients with hemisphere lesion induced epilepsy,the surgical procedure was closely related to the postoperative seizure control rate and the incidence rate of neurological dysfunction.And brain mapping was crucial for surgerystrategy management.