非肿瘤性枕叶癫癎的临床特点与手术治疗

Intractable occipital lobe non-tumor epilepsy; Clinical features and surgical outcome

  • 摘要: 目的:总结分析顽固性额叶癫痫手术治疗效果和经验。方法:回顾性分析2001年7月到2002年11月在我科接受手术治疗的20例枕叶癫痫病例,统计患者的发病、检查及手术治疗情况,并介绍相关手术体会。结果:18例(90%)以强直-痉挛性发作为主,65%有单侧为主的症状,17例(85%)有MRI影像异常,幻觉先兆8例(40%),术前应用128导长程视频脑电图检查定位局限于单侧枕叶14例(70%),颞枕叶5例(25%),双枕叶以一侧为主1例,与术中的皮层脑电图定位吻合率达到100%;手术包括病灶切除13例(65%),海马切除4例(20%),胼胝体切开1例,均行多处软膜下横切术,无远期手术并发症;术后疗效满意16例(80%),显著改善3例(15%)、良好1例(5%)。结论:顽固性非肿瘤枕叶癫痫患者的特点多有结构异常,以单侧为主的强直-痉挛性癫痫多见,幻视先兆常见,手术效果好。

     

    Abstract: Objective: To analyze clinical features and surgical outcome of intractable occipital epilepsy and introduce surgical experience. Methods: 20 surgical treated occipital lobe epilepsy cases were studied retrospectivelyt, the patients general clinical data, seizure features and surgical outcomes, and conclude surgical experiences of those patients. Results: There were 18 cases (90%) under general tonic-clonic seizures, 13 patients (65%) with lateralizing value or semiology of ictal limb posturing, 17 patients(85%) with abnormal CT/MRI images, 8 cases with vision auras; Epileptogenics were located unilateral occipital lobe in 14 cases(70%), unilateral temporo-occipital lobe in 5 cases(25%) and bilateral in 1 cases.13 cases were treated by lesionectomy and focal resection, 4 cases by amygdalohippocampotomy, 1 by corpus callosotomy.All patients were treated by multiple subpial transection (MST).Surgical result included 16(80%) satisfactory cases, 3 (15%) notable improvements, 1 (5%) good case. Conclusion: Intractable occipital epileptic patients always had abnormal MRI image, general tonic clonic seizure with unilateral severity sign, more vision auras and good surgical outcome.

     

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