摘要
目的探讨外伤性癫痫的临床特点、致痫灶位置与脑软化灶的关系和手术疗效。方法沈阳军区总医院神经外科自2003年2月至2006年4月共手术治疗难治性外伤性癫痫患者13例．对其临床资料进行回顾性分析。结果8例患者致痫灶位于外伤软化灶周围（2～7cm）；5例为颞叶癫痫，其中4例为颞叶内侧型（3例受伤时年龄1．5～5岁，术后病理显示海马胶质细胞增生）、1例为颞叶外侧型。13例患者均在皮层电极监测下行手术治疗，4例同期行颅骨修补术。经2-5年随访，总手术有效率92.3％，优良率84．6％。结论外伤性癫痫致痫灶常位于软化灶周围；小于5岁的重型颅脑损伤易导致海马硬化；难治性外伤性癫痫的手术疗效较好，一经诊断，应积极进行手术治疗。
Objective To investigate the clinical characteristics ofposttraumatic epilepsy, the correlation between epileptogenic loci and encephalomalacia, and the therapeutic effects of surgical intervention. Methods A retrospective analysis was performed among 13 patients with refractory post-traumatic epilepsy who received surgical intervention between February, 2003 and April, 2006. Results The first seizure attack occurred 0.5-13 years （mean 5.3 years） after craniocerebral injury in these patients. The epileptogenic loci were located around the encephalomalacia （ranging from 2 to 7 cm） in 8 patients, in the temporal lobe in 5 patients, in the medial temporal lobe in 4 patients （3 of whom sustained the injuries at 1.5-5 years of age with hippocampal glial proliferation shown by postoperative pathological examination）, and in the neocortex of the temporal lobe in 1 case. All the patients underwent the operations under close monitoring of the cortical electroencephalogram, and 4 also received cranioplasty. The total effective rate of the surgery was 92.3% with an excellent outcome rate of 84.6% in the follow-up for 2-5 years. Conclusion The epileptogenic loci of posttraumatic epilpsy are usually adjacent to the encephalomalacia, and hippocampal sclerosis can be likely in patients with severe cerebral injury below 5 years of age. Refractory posttraumatic epilepsy often has favorable surgical outcome, and prompt surgery is suggested after the diagnosis.
出处
《中华神经医学杂志》
CAS
CSCD
北大核心
2009年第6期605-607,共3页
Chinese Journal of Neuromedicine
关键词
外伤性癫痫
致痫灶
外科手术
Posttraumatic epilepsy
Epilepogenic foci
Surgical treatment
