CAJ | 학술논문

目的探讨外伤后晚期难治性癫痫的致痫灶精确定位、手术方法及其治疗效果.方法68例外伤后晚期难治性癫痫患者,采用神经影像学、视频脑电图、症状学以及术中皮层脑电图(ECoG)监测等方法综合定位致痫灶.采取单纯脑软化灶切除术治疗11例,脑软化灶+周边致痫皮层切除术治疗31例,脑软化灶+周边致痫皮层切除+功能区致痫皮层低功率电凝热灼术或多处软膜下横切术治疗20例,脑软化灶+周边致痫皮层切除术+胼胝体前部切开术治疗6例;17例同期行颅骨缺损修补术.术后继续正规服用抗癫痫药物.结果60例随访1~7年,EngelⅠ级21例,Ⅱ级32例,Ⅲ级4例,Ⅳ级3例,总有效率88.3%.具有精神症状的患者术后精神症状均明显缓解.出现暂时性轻偏瘫18例,永久性轻偏瘫2例,暂时性失语6例,颅内感染3例.结论手术是治疗外伤后晚期难治性癫痫的有效方法.术前准确定位致痫灶、术中ECoG监测及采取合适的术式是手术成功的关键.
목적탐토외상후만기난치성전간적치간조정학정위、수술방법급기치료효과.방법68예외상후만기난치성전간환자,채용신경영상학、시빈뇌전도、증상학이급술중피층뇌전도(ECoG)감측등방법종합정위치간조.채취단순뇌연화조절제술치료11례,뇌연화조+주변치간피층절제술치료31례,뇌연화조+주변치간피층절제+공능구치간피층저공솔전응열작술혹다처연막하횡절술치료20례,뇌연화조+주변치간피층절제술+변지체전부절개술치료6례;17례동기행로골결손수보술.술후계속정규복용항전간약물.결과60례수방1~7년,EngelⅠ급21례,Ⅱ급32례,Ⅲ급4례,Ⅳ급3례,총유효솔88.3%.구유정신증상적환자술후정신증상균명현완해.출현잠시성경편탄18례,영구성경편탄2례,잠시성실어6례,로내감염3례.결론수술시치료외상후만기난치성전간적유효방법.술전준학정위치간조、술중ECoG감측급채취합괄적술식시수술성공적관건.
Objective To investigate the precise location of epileptogenic foci, surgical technique and curative effect of surgery on late post-traumatic refractory epilepsy (LPTRE). Methods The epileptogenic foci was located by comprehensive analyzing data of neuro-imaging, video-electroencephalogram, clinical manifestation and intra-operative electrocorticogram (ECoG) in 68 patients with LPTRE. Only encephalodialysis foci (EF) were removed in 11 patients. EF and epileptogenic cortexes (EC) around EF were removed in 31. Removal of EF and EC around EF and the thermocoagulation of the epileptogenic functional cortexes or multiple subpial transection were performed in 20. EF and EC around EF were removed and the anterior corpus callosotomy was performed in 6. Results Of 60 patients followed up from 1 to 7 years, 21 received Engel grade Ⅰ therapeutic outcome, 32 grade Ⅱ, 4 grade Ⅲ, and 3 grade Ⅳ. The effective rate was 88.3%. The psychiatric symptom was obviously improved in all the patients. The complications included temporary hemiparesis in 18 patients, permanent hemiparesis in 2, temporary aphasia in 6 and intracranial infection in 3. Conclusions The surgery is an effective method to treat LPTRE. The preoperative precise location of the epileptogenic focis, intra-operative ECoG monitoring and suitable surgical modality are the keys to good curative effect in the patients with LPTRE.