目的　对部分复杂的顽固性癫痫病人 ,将几种手术结合使用 ,并对其临床效果进行评价。方法　北京天坛医院手术治疗顽固性癫痫 2 30例 ,其中对 15例顽固性癫痫病人采用几种术式结合的方法。病人年龄 9～ 4 3岁 ,平均 18岁。病程 4～ 4 0年 ,平均 13年。发作形式为强直阵挛性发作、复杂部分性发作及失神 ,其中有 8例存在两种发作形式。术前均服过多种抗癫痫药 ,病程后期同时服用 2～ 3种抗癫痫药。这 15例病人术前均行头皮脑电视频连续监测及头MRI检查 ,其中 5例行头PET检查。手术在皮层脑电及深部电极监测下进行。 13例行额颞开颅 ,胼胝体前部切开 +颞前叶及海马切除 +皮层热灼术 ;1例行额颞顶枕开颅 ,枕叶萎缩皮层切除 +胼胝体前部切开 +选择性海马切除 +皮层热灼术 ;1例先行左额颞开颅 ,脚间池错构瘤及颞前叶及海马切除 +皮层热灼术 ,术后癫痫减轻但仍发作且术后头皮脑电显示右额棘波明显 ,故又行右额颞开颅 ,胼胝体前部切开 +皮层热灼术。结果　术后无死亡及并发症。术后抗癫痫药物减少 ,术后 12例服用一种抗癫痫药 ,3例服用两种抗癫痫药。术后随访 3～ 12个月 ,14例无癫痫发作 ,1例癫痫发作两次 (术前每天发作 5～ 8次 )。结论　多种手术结合治疗顽固性癫痫病人安全有效 Objective To some complex intractable epilepsy patients, the combination of several kinds of surgery, and its clinical evaluation. Methods Beijing Tiantan Hospital surgical treatment of stubborn epilepsy in 230 cases, of which 15 cases of intractable epilepsy patients using several surgical methods. Patient age 9 ~ 43 years old, average 18 years old. Course of 4 ~ 40 years, an average of 13 years. Seizures in the form of tonic-clonic seizures, complex partial seizures and absence, of which there are eight cases of two seizures. A variety of anti-epileptic drugs were served before surgery, late at the same time taking 2 to 3 kinds of anti-epileptic drugs. These 15 patients underwent scalp EEG continuous monitoring and head MRI before surgery, of which 5 patients underwent PET examination. Surgery was performed under cortical EEG and deep electrode monitoring. 13 cases of frontotemporal craniotomy, anterior corpus callosum incision + temporomandibular and hippocampal resection + cortical cautery; 1 cases of frontotemporal roof craniotomy, occipital atrophy cortical excision + anterior corpus callosum incision + selective 1 case of left frontotemporal craniotomy, paraclavicular hamartoma and anterior temporal lobe and hippocampal resection + cortical cauterization, postoperative epilepsy but still attack and postoperative scalp EEG Right frontal spike obvious, it is OK right frontal temporal craniotomy, incision of the corpus callosum + cortical cautery. Results No postoperative death and complications. Postoperative antiepileptic drugs decreased, after taking 12 cases of an anti-epileptic drugs, 3 cases of taking two antiepileptic drugs. The patients were followed up for 3 to 12 months. There were 14 cases without epileptic seizures and 1 case with epileptic seizures (5 ~ 8 episodes per day before operation). Conclusion A variety of surgical treatment of intractable epilepsy patients safe and effective