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目的总结分析儿童顽固性癫手术治疗效果和经验。方法回顾性分析2007年4月—2009年9月期间手术治疗的22例14岁以下的儿童顽固性癫病例,统计患儿的发病、检查及手术治疗情况,手术方式的选择应依据患儿术前脑电图与术中皮层脑电图的定位情况而进行。结果 22例患儿,年龄3～14岁,平均年龄8.64岁,病程平均4.9年,影像学异常9例,智商明确缺陷10例,14例以强直-痉挛性发作为主。病灶位于颞叶11例,额叶5例,额颞叶5例,顶叶1例。手术行病灶切除及前颞叶切除11例,选择性海马-杏仁核切除4例,胼胝体切开11例,单纯多处软膜下横切1例。术后出现一过性对侧轻瘫3例,一过性语言不利2例。术后疗效满意20例占90.9%(20/22),良好1例占4.5%(1/22),好转1例占4.5%(1/22)。结论合理的选择手术方式,对儿童期顽固性癫痫手术治疗,手术效果良好、安全。
Objective To summarize and analyze the effect and experience of intractable epilepsy in children. Methods Retrospective analysis of 22 cases of intractable epilepsy in children under 14 years of age undergoing surgery from April 2007 to September 2009 retrospectively analyzed the incidence, examination and surgical treatment of children. The choice of surgical method should be based on EEG and intraoperative cortical EEG location. Results Twenty-two children aged from 3 to 14 years, with an average age of 8.64 years, had an average duration of 4.9 years, 9 cases of abnormal imaging, 10 cases of definite IQ and 14 cases of ankylosing spasm. The lesions were located in temporal lobe in 11 cases, frontal lobe in 5 cases, frontal temporal lobe in 5 cases, parietal lobe in 1 case. Eleven patients underwent resection of the lesion and anterior temporal lobectomy. Selective hippocampus-appendectomy was performed in 4 patients, corpus callosum in 11 patients and transection in 1 patient. There was a transient contralateral paresis after surgery in 3 cases, a transient language adverse in 2 cases. Satisfactory results were obtained in 20 cases (90.9%, 20/22), in 1 case (4.5%, 1/22) and in 1 case (4.5%, 1/22). Conclusion A reasonable choice of surgical approach to childhood intractable epilepsy surgery, the effect of surgery good and safe.