李志涛;尹绍雅;岳伟;王金环;冯珂珂;李清云;冯梅;

• 1:天津医科大学研究生院
• 2:天津市环湖医院神经外科
• 3:天津市环湖医院神经内科
• 4:天津市环湖医院神经电生理

摘要(Abstract)：

目的总结8例大脑前额叶孤立术治疗顽固性癫痫的临床经验,探讨采用完全额叶孤立术治疗顽固性癫痫的可行性。方法以大脑半球切开术及后象限切开术为基础术式,将彻底孤立致痫灶的概念引入这种病例的治疗中,对8例致痫灶切除术后无效的额叶癫痫患者施行了额叶孤立术,为保证前额叶彻底孤立,在额叶切开的同时离断前连合和胼胝体前部。术后随访16个月,16个月后对8例患者统一以Engel分级法评估手术疗效。结果 8例患者手术过程均顺利,2例术后发热,行腰大池引流术,均恢复良好。术后疗效评估Engel分级Ⅰ级(术后癫痫停止发作)5例,Ⅱ级(每年发作1~2例)2例,Ⅲ级(发作频率减少75%以上)1例。结论前额叶孤立术可能是治疗难治性额叶癫痫的比较有效的方法之一。

关键词(KeyWords)： 额叶癫痫;孤立术;切开术;前连合;胼胝体

Abstract:

Keywords:

基金项目(Foundation): 天津市卫生技生委科技基金(2014KG116)

作者(Author): 李志涛;尹绍雅;岳伟;王金环;冯珂珂;李清云;冯梅;

Email:

DOI:

参考文献(References)：

• [1]Massager N,Tugendhaft P,Depondt C,et al.Long-term outcome of surgical disconnection of the epileptic zone as an alternative to resection for nonlesionalmesial temporal epilepsy[J].J Neurol Neurosurg Psychiatry,2013,84(12)1378-1383.
• [2]Kovanda TJ,Rey-Dios R,Travnicek J,et al.Modified periinsular hemispherotomy:operative anatomy and technical nuances[J].J Neurosurg Pediatr,2014,13(3):332-338.
• [3]Dorfer C,Czech T,Dressler A,et al.Vertical perithalamic hemispherotomy:a single-center experience in 40 pediatric patients with epilepsy[J].Epilepsia,2013,54(11):1905-1912.
• [4]Bulteau C,Otsuki T,Delalande O.Epilepsy surgery for hemispheric syndromes in infants:hemimegalencepahly and hemispheric cortical dysplasia[J].Brain Dev,2013,35(8):742-747.
• [5]苏崇德,常鹏飞,于龙.大脑后部离断术治疗难治性癫痫1例临床分析[J].立体定向和功能性神经外科杂志,2012,25(4):247-250.
• [6]关宇光,栾国明,周健.大脑半球离断术治疗儿童难治性癫痫[J].中华神经外科杂志,2012,28(10):994-997.
• [7]尹绍雅,冯珂珂,岳伟,等.半球切开术治疗顽固性癫痫[J].中华神经外科杂志,2013.29(7):714-718.
• [8]尹绍雅,冯梅,李清云,等.大脑半球后象限切开术治疗颞顶枕叶癫痫二例并文献复习[J].中华神经外科杂志,2013.29(12):1235-1236.
• [9]Sugano H,Nakanishi H,Nakajima M,et al.Posterior quadrant disconnection surgery for Sturge-Weber syndrome[J].Epilepsia,2014,55(5):683-689.
• [10]袁冠前,薛洪利,吕搏川,等.难治性外伤性癫痫的手术治疗分析[J].中华神经医学杂志,2009.8(6):605-607.
• [11]王晓峰,姬仲,吴永明,等.脑电趋势图监护在神经重症监护病房对癫痫及亚临床癫痫的诊断意义[J].中华神经医学杂志,2009.8(10):1041-1045.
• [12]Lew SM,Matthews AE,Hartman AL,et al.Posthemispherectomy hydrocephalus:results of a comprehensive,muti-institutional review[J].Epilepsia,2013,54(2):383-389.
• [13]Yin SY,Feng KK,Yue W,et al.Posterior quadrantic disconnection maintains the activity of isolated temporalparietal-occipital nerve tissue:neuroprotective measures in the surgical treatment of epilepsy[J].Neural Regen Res,2014.9(4):447-448.
• [14]郭效东,王本瀚,吴艳芝,等.额叶离断术治疗无影像学异常的难治性额叶癫痫[J].中华神经外科杂志,2013,29(5):512-515.
• [15]Kim DL,Osburn LL,Cohen Gadol AA.A novel method for confirmation of hemispheric disconnection during hemispherotomy surgery[J].Pediatr Neurosurg,2010,46(1):71-75.
• [16]Waseem H,Vivas AC,Vale FL.MRI-guided laser interstitial therapy for treatment of medically refractory non-lesional mesial temporal lobe epilepsy:Outcomes,complications,and current limitations:A review[J].J Clin Neurosci,2016,60(1):45-50.