摘要
目的 探讨唤醒下手术治疗中央区癫痫的临床效果.方法 回顾性分析我科手术治疗的548例癫痫患者的临床资料,12例符合本研究标准.综合评估后在相应部位埋置颅内电极,经颅内电极脑电图（Intraeranial-EEG i-EEG）确定癫痫起始区（epileptic onset zone,EOZ）、皮层电刺激（cortical electro-stimulation,CES）描记脑功能区后,在麻醉唤醒状态下切除EOZ区及周围异常组织,以更好的保留脑功能.对切除组织进行病理学研究.结果 EOZ位于中央前-后回者3例（左侧1例、右侧2例）、中央前回者6例（左侧2例、右侧4例）、中央后回者3例（左侧1例、右侧2例）.病理学证实：皮质发育不良7例（ⅡA型3例、ⅡB型2例、灰质异位2例）、脑囊虫2例、脑软化灶（胶质增生）2例、海绵状血管瘤1例.随访2～5年,均系统服用抗癫痫药物（2例遵医嘱停服）,癫痫发作完全消失（Engel-Ⅰ级）7例、有发作先兆且偶有发作（Engel-Ⅱ级）3例、发作次数减少（Engel-Ⅲ级）2例.手术后早期出现运动-浅感觉功能障碍者2例、单纯运动功能下降者5例、出现深-浅感觉功能减退者1例.经半年的功能康复训练,6例患者运动功能恢复、感觉功能部分恢复,2例患者仍轻偏瘫,但肢体远端精细功能部分恢复.结论 EOZ位于中央区也可行切除性手术,术中唤醒能更好的保护脑功能.
Objective To explore the clinical effects of awake surgery for Rolandic＇ s epilepsy. Methods The clinical data of 548 patients with epilepsy operated in our department were analyzed retrospectively. 12 cases of them were Rolandic＇ s epilepsy who had underwent awake surgery for epileptogenic zone（EOZ） resection after preoperative comprehensive evaluation, including their MRI scan, i-EEG monitoring and cortical electro-stimulation （CES）. Pathological study was performed to analyze the tissue natures. Results There were 3 cases whose EOZ were located in both pre- and post-central gyri areas, and 6 in pre-central gyri and 3 in post-central gyri. The results of the pathologies included malformation of cortical dysplasie （7 cases ）, cerebral eysticercosis （2 cases ）, encephalomalacia（2 cases） and cavernous hernangioma（ 1 case）. After 2 to 5 years follow-up ,7 cases were seizure free（Engel-I）,3 had aura attack and occasionally seizures（Engel-H） and 2 had lesser attack（Engel-m） than pre-operation. All cases were constant drug treatment except 2 cases drug withdrawal after listening to doctor＇ s advice. Surgical complications were found in post-operative early time with 2 cases having dysfunction in movement and superficial sensibility, 5 cases in movement and 1 case in proprioceptive and superficial sensibility. Rehabilitation nursing had been used to help them for half a year, 5 cases were recovered to normal movement and 3 had mild paralysis with bad fine motor functions in limb extremities. Conclusion Awake surgery can protect the cerebral function more carefully during EOZ resection in central areas.
出处
《临床神经外科杂志》
CAS
2013年第6期323-325,328,共4页
Journal of Clinical Neurosurgery
基金
国家自然科学基金(81071211)
关键词
中央区癫痫
唤醒手术
手术并发症
Rolandic ＇ s epilepsy
awake surgery
surgical complication
