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目的探讨颅脑术后继发的难治性癫痫的术前评估方法及适应证选择,总结二次开颅手术切除致痫灶的经验,以提高颅脑术后继发癫痫的治疗效果。方法 2005年1月-2012年5月行手术治疗的颅脑术后继发癫痫患者25例,术前认真评估,仔细询问病史,并行视频脑电图(V-EEG)检查,每位患者均接受发作期和发作间期脑电图检查,或颅内埋置硬膜下电极。根据脑电图、MRI、CT平扫及加强扫描确定癫痫病灶。手术按原颅脑手术切口入路,切开硬脑膜,充分显露脑瘢痕区,采用皮层电极详细探测致痫灶棘波区的位置及范围,在显微镜下一并切除脑组织瘢痕和致痫灶,切除后再次采用皮层电极监测,直到脑电节律正常为止。结果 25例手术均顺利,无死亡病例,无严重手术并发症。术后随访6个月～7年,发作控制EngleⅠ级18例,EngleⅡ级5例,EngleⅢ级2例;18例(72%)无发作,其中9例已停药。结论颅脑术后继发癫痫药物治疗效果欠佳,二次开颅手术可取得满意疗效。
Objective To explore the preoperative evaluation of intractable epilepsy after craniocerebral surgery and the selection of indications. The experience of resection of epileptic foci by secondary craniotomy was summarized in order to improve the therapeutic effect of secondary epilepsy after craniocerebral surgery. Methods From January 2005 to May 2012, 25 patients with secondary epilepsy after craniocerebral operation underwent surgical treatment. The patients were carefully evaluated preoperatively, history was carefully examined, and video-electroencephalogram (V-EEG) examination was performed. Each patient EEG and epileptic seizures during epidural examination, or intracranial embedded subdural electrodes. According to EEG, MRI, CT plain scan and enhanced scan to determine epilepsy lesions. Surgical incision according to the original craniotomy approach, incision dura mater, fully exposed brain scar area, the use of cortical electrodes to detect the location and extent of epileptic fissures area, and under the microscope to remove the brain tissue scar and epileptogenic focus , Resection using cortical electrodes again until the rhythm of normal brain so far. Results 25 cases of operation were smooth, no deaths, no serious complications. The postoperative follow-up ranged from 6 months to 7 years. There were 18 cases of Engle grade I, 5 cases of Engle grade II and 2 cases of Engle grade. There were no seizures in 18 cases (72%), of which 9 cases were discontinued. Conclusion The treatment of epilepsy after craniocerebral surgery is ineffective, and the second craniotomy can achieve satisfactory curative effect.