摘要
目的探讨垂直入路大脑半球离断术治疗病变累及一侧大脑半球的药物难治性癫痫(DRE)的可行性及疗效。方法纳入2021年5月至2024年12月于昆明三博脑科医院癫痫中心采用垂直大脑半球离断术治疗的16例DRE患者,术后均规律足量口服抗癫痫发作药物。回顾性观察手术的并发症及疗效。采用Engel分级标准评估癫痫的控制情况。结果16例患者手术过程均顺利,手术时间为(297.6±90.0)min;术中出血量为(243.8±85.4)ml,无一例患者术中输血。术后影像学显示大脑半球离断完全;发生颅内感染1例、孤立性脑积水1例,经治疗后均康复。术后6个月因非原发病死亡1例;其余15例患者随访时间为(32.7±13.8)个月(13~56个月),随访期13例患者无癫痫发作,Engel分级为Ⅰ级;2例有癫痫发作,Engle分级为Ⅱ级。16例患者术后均出现不同程度的一侧肢体活动障碍,经康复治疗后均好转,其中6例恢复至术前水平。结论垂直入路大脑半球离断术治疗累及一侧大脑半球的DRE患者癫痫发作控制情况好,术中出血量少。
Objective To assess the feasibility and efficacy of vertical hemispherotomy for the treatment of drug-resistant epilepsy(DRE)in patients with unilateral hemispheric disease.Methods A total of 16 DRE patients treated with vertical hemispherotomy at the Epilepsy Center of Kunming Sanbo Brain Hospital between May 2021 and December 2024 were included.All patients received regular,adequate doses of antiseizure medicines postoperatively.A retrospective analysis was conducted to observe the surgical complications and outcomes.The Engel classification was used to assess the control of epileptic seizures.Results All 16 patients had successful operations,with a mean surgical duration of 297.6±90.0 minutes and an average intraoperative blood loss of 243.8±85.4 ml.No patients required intraoperative blood transfusion.Postoperative imaging confirmed complete hemispherotomy.Postoperative complications included one case of intracranial infection and one case of isolated hydrocephalus,both of which were resolved with treatment.One patient died six months postoperatively due to non-primary disease.The remaining 15 patients had a mean follow-up period of 32.7±13.8 months(range:13-56 months).Among them,13 patients were seizure-free with Engel classⅠ,and 2 patients had seizures with Engel classⅡ.Postoperative motor impairments on the affected side were observed in all 16 patients,which improved with rehabilitation,with 6 patients returning to preoperative functional levels.ConclusionVertical hemispherotomy is an effective approach for the treatment of DRE with unilateral hemispheric involvement,demonstrating good seizure control and minimal intraoperative blood loss.
作者
赵永彬
田杨
高菁
和磊洁
李爱仙
薛晋和
任杰
栾国明
Zhao Yongbin;Tian Yang;Gao Jing;He Leijie;Li Aixian;Xue Jinhe;Ren Jie;Luan Guoming(Epilepsy Center,Kunming Sanbo Brain Hospital,Kunming 650100,China;Department of Neurosurgery,Sanbo Brain Hospital,Capital Medical University,Beijing 100093,China)
出处
《中华神经外科杂志》
北大核心
2026年第2期161-166,共6页
Chinese Journal of Neurosurgery
