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目的探讨采用多软脑膜下横切术治疗功能区顽固性癫痫发作和保护皮质功能的可行性。方法选择20例顽固性癫痫病人(其痫性放电均累及主要功能区)。切开硬脑膜后,先用皮质电极确定致痫灶,再横切传导痫性放电的神经元树突纤维,一直到棘尖波完全消除为止。结果术后随访6～35个月,癫痫控制满意6例,显著改善6例,良好5例,减轻2例,无改善1例,总有效率为95%,无手术死亡。结论多软脑膜下横切术在不引起显著神经功能缺失的情况下,能较有效地控制癫痫发作,因而是治疗功能区顽固性癫痫的首选方法。
Objective To explore the feasibility of using multiple subdural transection in the treatment of intractable epileptic seizures and protective cortical function in functional areas. Methods Twenty patients with intractable epilepsy (their epileptiform discharges involved the major functional areas) were selected. Cut the dura after the first use of cortical electrodes to determine the epileptogenic focus, and then transection of epileptiform discharge neuronal dendritic fibers, until the spike wave completely eliminated so far. Results The patients were followed up for 6 to 35 months. There were 6 cases with satisfactory control of epilepsy, 6 cases improved significantly, 5 cases improved, 2 cases reduced, 1 case without improvement. The total effective rate was 95%. There was no operative death. Conclusions Multiple sub-meningeal transection can control seizures more effectively without causing significant neurological deficits, and is therefore the first choice for the treatment of intractable epilepsy in functional areas.