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目的应用患侧大脑半球多脑叶离断术治疗该侧半球性病变导致的难治性癫痫,目的是对保留病变半球基本功能的癫痫患者提出一个有效而实用的术式。方法①大脑半球多脑叶离断术的创新:对患侧大脑半球我们分步骤离断额叶,颞叶、和顶枕叶与丘脑、基底节的联系;通过侧脑室额角和枕角离断胼胝体前后部,只保留中央前后回皮层及其与丘脑、基底节和内囊的联系;通过外侧裂切除岛叶皮层;通过颞角切除海马杏仁核。②利用这一术式我们治疗了5例大脑半球病变引发的难治性癫痫患者。结果该术式在5例患者成功实施。结果证实,该手术创伤小,并发症少,术后病人没有任何加重对侧肢体功能障碍的并发症,癫痫得到有效控制。随访13～20个月,Engel I级3例;II级2例。结论大脑半球多脑叶离断术,是对那些保留运动、感觉和语言功能的半球性病变所致的难治性癫痫患者有效、可靠的治疗选择。
Objective To treat refractory epilepsy caused by hemispheric lesion in this hemisphere by using ipsilateral hemispheric multilobar lobectomy in order to provide an effective and practical procedure for patients with epilepsy who retain the basic hemispheric function. Methods ① Innovation of cerebral hemispheres multilobar breakage: we separated the frontal lobe, temporal lobe, and the top occipital lobe from the thalamus and basal ganglia in the ipsilateral cerebral hemisphere; The anterior and posterior cortex of the corpus callosum only retained the central anterior and posterior cortex and its connection to the thalamus, basal ganglia and internal capsule; the island cortex was excised by lateral fissure; and the hippocampus almond nucleus was excised by the temporal angle. ② The use of this technique we treated 5 patients with cerebral hemispheres caused by refractory epilepsy patients. Results The procedure was successfully performed in 5 patients. The results confirmed that the surgical trauma is small, fewer complications, postoperative patients without any aggravation of complications of contralateral limb dysfunction, epilepsy is effectively controlled. Followed up for 13 to 20 months, 3 cases of Engel class I and 2 cases of class II. Conclusions Cerebral hemisphere lobectomy is an effective and reliable treatment option for patients with refractory epilepsy due to hemispheric lesions that retain motor, sensory, and speech functions.