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目的介绍一种新的治疗后脑病变引起的难治性癫痫的手术方法——大脑后部离断术,并就该手术方法和适应证进行讨论。方法应用大脑后部离断术治疗1例左侧后皮层广泛病变引发的成年难治性癫痫患者。该患者左侧顶叶、枕叶、颞叶脑软化、坏死、萎缩,但中央前后回和额叶皮层结构完整,左侧运动感觉语言功能仍然存在。手术方法为彻底离断顶枕叶、颞叶。结果手术后癫痫得到有效控制,随访6个月,只有2次轻微的复杂部分性发作,Engel分级Ⅱ级,没有新的神经损害并发症发生。结论后脑离断术可以有效治疗大脑后皮层病变所致的难治性癫痫,较多脑叶切除术有手术创伤小、省时、并发症少的优点。
OBJECTIVE: To introduce a new surgical method of intractable epilepsy induced by encephalopathy after cerebral hemorrhage, and to discuss the surgical methods and indications. Methods One case of adult refractory epilepsy caused by extensive lesions of the left posterior cortex was treated with posterior cerebral disconnection. The left parietal lobe, occipital lobe, temporal lobe brain soften, necrosis, atrophy, but the central front and back and the frontal cortex structural integrity, left motor function of language features still exist. Surgical methods for the complete break off the top occipital lobe, temporal lobe. Results The postoperative epilepsy was effectively controlled. After 6 months follow-up, there were only 2 minor complicated partial seizures and Engel grade Ⅱ. There was no new neurological damage complication. Conclusions Posterior brain surgery can effectively treat intractable epilepsy induced by posterior cerebral cortex lesions. Compared with the treatment of small brain lobectomy, it has the advantages of less trauma, less time and fewer complications.