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目的 采用低功率热灼的方法 ,毁损脑皮层的横行纤维 ,治疗功能区顽固性癫痫 ,观察该方法在临床的实用性和有效性。方法 12 4例难治性癫痫患者 ,手术切除非功能区致痫灶后 ,辅助热灼功能区的致痫灶或癫痫样放电。非功能区致痫灶切除前后、功能区致痫灶热灼前后均行皮层脑电图监测。病理观察热损伤的深度和范围。结果 热灼后肉眼下见 :皮层呈红白相间的条纹状改变 ,与多软膜下横纤维切断术 (MST)类似。显微结构见 :热损伤仅在脑浅表皮层 (Ⅰ～Ⅲ )。随访 10 8例术后病例 1～ 5年 ,癫痫发作消失的占 75 9% ,总有效率 91 7%。术后 9例病人出现一过性的功能障碍 ,但均在一周左右恢复。结论 非功能区致痫灶切除辅助功能区致痫灶热灼 ,其疗效肯定 ,方法安全可靠 ,易在临床推广。
Objective To treat the functional epilepsy by observing the practicability and effectiveness of this method in the clinical use of low-power thermal cauterization, destroying transverse cortical fibers in the cerebral cortex. Methods Twenty-four patients with intractable epilepsy were enrolled in this study. The epileptogenic zone or epileptiform discharge was assisted by epileptogenic zone after non-functional area excision. Non-functional areas before and after epileptogenic resection, functional areas of epileptic foci before and after cortical EEG monitoring. Pathological observation of the depth and extent of thermal damage. Results After thermal burns, the naked eye saw the cortical red-and-white stripe changes similar to those of subrethral transection (MST). Microstructure see: thermal damage only in the superficial layer of the brain (Ⅰ ~ Ⅲ). Follow-up of 108 cases of postoperative cases of 1 to 5 years, 75% of seizures disappeared, the total effective rate 91.7%. Postoperative 9 patients had transient dysfunction, but recovered in about a week. Conclusion Non-functional area epileptogenic zone resection auxiliary function area epileptogenic focus cauterization, its efficacy is sure, the method is safe and reliable, easy to clinical promotion.