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目的探索胼胝体全段一期切开的安全性,观察该术式治疗癫疒间性脑病的有效性。方法回顾性分析我科手术治疗的37例癫疒间性脑病的临床资料。经临床症状学、神经电生理学、神经影像和神经心理学综合评估后,于全麻下额部切口、经前纵裂入路显微镜下一期切开胼胝体全段。依Engel分级标准评判手术效果。结果随访18～34个月,Engel-Ⅰ级3例,Engel-Ⅱ级25例,Engel-Ⅲ级7例,Engel-Ⅳ级2例,手术总有效率达75.7%。跌倒发作、强直发作、痉挛发作和强直-阵挛发作的有效率分别为86.2%、77.5%、61.6%和40.8%。14例患者出现不同程度的手术后并发症,缄默11例、轻偏瘫7例、颅内感染1例。其中13例患者分别在出院时和出院后1月内痊愈,1例患者仍遗留轻偏瘫。结论胼胝体全段一期切开安全、微创,无新发并发症;它能有效减少癫疒间性脑病的癫疒间发作频率、减轻发作程度。
Objective To explore the safety of the first-stage incision of the corpus callosum and to observe the effectiveness of the surgical treatment of epileptic encephalopathy. Methods The clinical data of 37 cases of epileptic encephalopathy treated with surgical treatment in our department were retrospectively analyzed. After the clinical symptomology, neuroelectrophysiology, neuroimaging and neuropsychological comprehensive assessment, under general anesthesia in the frontal incision, anterior longitudinal cleavage approach under a microscope incision of the corpus callosum whole. The Engel grading criteria were used to evaluate the effect of surgery. Results The follow-up ranged from 18 to 34 months. There were 3 cases of Engel-Ⅰ grade, 25 cases of Engel-Ⅱ grade, 7 cases of Engel-Ⅲ grade and 2 cases of Engel-Ⅳ grade. The total effective rate was 75.7%. The effective rates of falls, tonic seizures, spastic seizures and tonic-clonic seizures were 86.2%, 77.5%, 61.6%, and 40.8%, respectively. Fourteen patients had varying degrees of postoperative complications, including 11 cases of silent, 7 cases of hemiparesis and 1 case of intracranial infection. Thirteen patients were cured at discharge and within 1 month after discharge, respectively. One patient still had hemiparesis. Conclusions The first stage of the corpus callosum is safe, minimally invasive and has no new complications. It can effectively reduce the frequency of epileptic seizures and reduce the severity of seizures.