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目的研究器质性癫痫的病变组织切除后,癫痫灶是否随之消失,异常的脑电波形范围(距离)及波形特旆。方法随机取首发症状为癫痫的脑内有器质性病灶的患者11例。手术方法:切除病灶的同时,在EcoG的监测下行致痫灶切除(如在功能区则行MST),复查至癫痫波消失后方结束手术。随访3-37月,术后要求患者抗癫痫治疗至少1年。结果①手术中,病灶均成功切除;②病理见脑囊虫病3例,AVM 2例,脑肺吸虫1例,脑胶质瘤2例,蛛网膜囊肿2例,脑炎性肉芽肿1例;③10例经EcoG、DeepEEG检查发现有癫痫样异常波形(10/11),所发现的异常波形以尖波为多见,棘波仅2例,在残腔周围0.5-5cm范围,深亦可达5cm;④随访11例中,1例胶质瘤患者死亡(术后4个月,死于胶质瘤复发),余均健在。癫痫症状发作情况:发作消失7例,1-2次/年2例,发作减少75%1例,发作减少50%1例。结论以癫痫为首发症状的器质性癫痫患者,仅切除原发病灶,并未能消除致癫痫病灶,可为术后癫痫发作埋下隐患,有条件时,应在切除原发病灶的,同时切除致痫灶。
Objective To study whether the epileptic foci disappear, the scope of the abnormal EEG waveform (distance) and the special waveform after the resection of organic epilepsy. Methods Randomly take the first symptom of epilepsy brain organic lesions in 11 patients. Surgical methods: resection of the lesion at the same time, EcoG under the monitoring of epileptic foci removal (such as MST in the functional area), review to the epileptic wave disappeared after the end of surgery. Follow-up 3-37 months, postoperative patients with anti-epileptic treatment for at least 1 year. Results ① All the lesions were successfully resected during operation. ② Pathology showed 3 cases of cysticercosis, 2 cases of AVM, 1 case of cerebral fluke, 2 cases of glioma, 2 cases of arachnoid cyst and 1 case of encephalitis granuloma; Cases of abnormal epileptiform waveforms (10/11) were found by EcoG and DeepEEG examination. The abnormal waveforms were found to be spike waves, spike wave only 2 cases, the range of 0.5-5 cm around the residual cavity, and the depth of up to 5 cm ; ④ Follow-up of 11 cases, one case of glioma patients died (4 months after surgery, died of glioma recurrence), Yu Jun are alive. Epilepsy Symptoms: Seizures disappeared in 7 cases, 1-2 times / year in 2 cases, seizures decreased by 75% in 1 case, attack reduced by 50% in 1 case. Conclusion Epilepsy as the first symptom of organic epilepsy patients, only the removal of the primary lesion, and failed to eliminate the epileptic lesion can be hidden for postoperative epilepsy, when conditions should be in the removal of the primary lesion, at the same time Excision of epileptogenic lesions.