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目的探讨难治性癫痫的致病灶定位和术式选择。方法回顾分析36例难治性癫痫患者的临床资料,术前均行视频脑电监测(VEEG)和CT/MR检查,结合临床症状定位致痫灶。采用颞前叶及海马、杏仁核切除+广泛致痫皮层低功率电凝热灼25例;额叶癫痫+周围皮层低功率皮层热灼术5例,病灶及周围皮层切除+低功率皮层热灼术4例,行单侧病灶切除+胼胝体前部切开+致痫皮层低功率电凝热灼2例。结果经6个月至3年的随访,满意29例,显著改善5例,良好2例。结论部分性发作的癫痫患者,最可靠的治疗方法是致痫灶的切除,但对于全面性发作的病人,其致痫区往往比较广泛而无法切除,联合皮层热灼术可以减少发作频率、减轻发作程度和改变发作形式,提高治疗效果。准确定位致病灶,选择恰当的手术方式是外科治疗难治性癫痫取得良好效果的关键。
Objective To investigate the location of lesions and the choice of surgical procedure in intractable epilepsy. Methods The clinical data of 36 patients with refractory epilepsy were retrospectively analyzed. VEEG and CT / MR were performed preoperatively, and the epileptogenic focus was determined by clinical symptoms. In the anterior temporal lobe and hippocampus, amygdal resection plus extensive epileptic cortex low-power electrocorticic cauterization in 25 cases; frontal lobe epilepsy + peripheral cortical low-power cortical cauterization in 5 cases, lesion and peripheral cortex resection + low-power cortical cauterization Surgery in 4 cases, unilateral lesion resection + anterior incision of the corpus callosum + epileptic cortex low power electrocorticic cauterization in 2 cases. Results After 6 months to 3 years follow-up, 29 cases were satisfied, 5 cases were significantly improved and 2 cases were good. Conclusions The most reliable treatment for partial epilepsy is epileptogenic resection. However, for patients with generalized seizures, the epileptogenic zone is often rather unresectable. Combined cortical cauterization can reduce the frequency of seizures and reduce the frequency of seizures The extent of attack and change the attack form, improve the therapeutic effect. Accurate localization of lesions, choose the appropriate surgical approach is the surgical treatment of refractory epilepsy achieved good results.