【作者】 向军； 蒋宇钢；

【机构】 中南大学湘雅二医院神经外科；

【摘要】 目的对我科近年来收治的108例儿童难治性癫痫手术患者进行分析。方法分析108例儿童难治性癫痫患者的发作类型,手术前后抗癫痫药比较,神经影像学及视频脑电图检查,诊断及病理以及外科治疗方式。结果男58例,女50例,癫痫发作形式:SPS 21例,CPS 25例,GTCS 33例,GTS 9例,GCS 4例,SGS 6例,失神发作10例。术前服用抗癫痫药:一种26例,两种20例,三种及三种以上62例,术后服用抗癫痫药:一种70例,两种34例,三种及三种以上4例,神经影像检查阳性95例,阴性13例,VEEG呈局灶性95例,全导13例。颞叶癫痫行颞前叶+颞叶内侧结构切除30例,颞前叶切除1例,颞叶病灶切除8例,颞叶内侧结构切除2例,非颞叶癫痫行病灶切除32例,选择性皮层切除2例,皮层切除+热灼6例,皮层热灼5例,多脑叶切除1例,大脑半球切除:功能性1例,解剖性1例;另外手术行胼胝体切开+皮层热灼17例,迷走神经刺激2例。术后无死亡及并发症,随访4-14个月,90例无发作,18例发作频率较术前明显减少和/或发作程度减轻。结论儿童难治性癫痫应根据患者的临床表现,神经影像学及视频脑电图等结果进行详细的评估,采取不同的手术治疗方式,可取得良好的治疗效果。更多还原

【Abstract】 Objective To analyze 108 children with refractory epilepsy who have been surgically treated in our department. Methods The seizure types of the 108 cases of refractory epilepsy were analyzed, the comparison between antiepileptic drugs taken before surgery and those taken after surgery was made, neuroimaging and VEEG examinations were performed, and the diagnoses, pathology and surgical approaches of the disease were reviewed. Results Among 108 children(58 males, 50 females), in terms of the seizure types, SPS was seen in 21 cases, CPS in 25, GTCS 33, GTS 9, GCS 4, SGS 6, and absence seizure 10. Before surgery, 26 children took one type of antiepileptics, 20 took two types of antiepileptics, and 62 took three or more than three types of antiepileptics. After surgery, 70 children took one types of antiepileptics, 34 took two types of antiepileptics, and 4 took three or more than three types of antiepileptics. Positive neuroimaging results were seen in 95 cases, while negative ones in 13 cases. VEEG showed focal seizures in 95 cases, and VEEG showed generalized spike/spikes and wave in 13 cases. 30 children with temporal lobe epilepsy underwent anterior temporal lobectomy and medial temporal lobectomy; 1 case underwent anterior temporal lobectomy; 8 cases underwent temporal lesionectomy; 2 underwent medial temporal lobectomy; 32 children with non-temporal lobe epilepsy underwent lesionectomy, 2 case underwent selective cortical resection, 6 underwent cortical resection and cortex thermo-coagulation; 5 underwent cortex thermo-coagulation; 1 underwent multi-lobectomy; 1 underwent functional hemispherectomy, 1 underwent anatomical hemispherectomy; 17 cases underwent corpus callosotomy plus cortex thermo-coagulation; and 2 case underwent vagus nerve stimulation. No patient was dead after surgery and there were not any postsurgical complications. During 4-14 month follow-up, no recurrence of epilepsy was observed in 90 cases. In other 18 cases, the frequency of seizure and/or severity of seizure decreased compared with those before surgery. Conclusion In the treatment of refractory epilepsy in children, satisfactory therapeutic effects could be achieved by means of different surgical approaches after careful assessment based on the clinical manifestations and the results of neuroimgining and VEEG of the patients.更多还原