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目的探讨多处软膜下核切术（ＭＳＴ）结合病灶切除或脑叶切除对顽固性癫痫的治疗。方法术前借助影像学和脑电图定位，术中皮层脑电图地毯式探查，对非功能区病灶予以切除，其周围行ＭＳＴ直至痫波消失；对无明显病灶，广泛脑电异常还涉及颞叶者，特别是探查到杏仁核区及海马区有痫波者，除行ＭＳＴ外还要切除前颞叶（包括杏仁核及海马）；对于重要功能区有痛波者行ＭＳＴ，如果其中有明确的占位病变同时行ＣＴ立体定向导引下占位病变切除术。术后抗痫药治疗２年逐渐减量或停药。结果本组１１例无手术死亡和严重并发症。仅２例术后数天内有一侧肢体肌力下降，但很快恢复正常。随访１～５年，９例无癫痫发作，２例在１１年内尚有小发作；脑电图复查癫痫波消失，或原广泛中重度脑电异常改变为小范围轻度异常。结论ＭＳＴ结合病灶切除或脑叶切除对顽固性癫痫治疗能保留更多正常脑组织和取得更好的疗效。
Objective To investigate the treatment of intractable epilepsy by multiple subretinal kits (MST) combined with focal resection or lobectomy. Methods Preoperative imaging and electroencephalography, intraoperative cortical EEG carpet exploration, resection of lesions in non-functional areas, around the MST until the disappearance of the epileptic wave; no obvious lesions, extensive EEG also involves Temporal lobe, in particular to explore the amygdala and hippocampus epileptic wave who, in addition to line MST but also removal of the anterior temporal lobe (including the amygdala and hippocampus); for important functional areas have MST wave pain if Clear space-occupying lesions at the same time under the guidance of CT stereotactic space-occupying lesions. After 2 years of anti-epileptic drug treatment tapering or withdrawal. Results The group of 11 patients without surgical death and serious complications. Only two cases of one limb muscle strength decreased within a few days after operation, but returned to normal soon. Follow-up 1 to 5 years, 9 cases without epileptic seizures, 2 cases in 11 years there are still minor seizures; EEG disappearance of epilepsy wave review, or the original wide range of moderate to severe EEG changes to a small range of mild abnormalities. Conclusion MST combined with focal resection or lobectomy for refractory epilepsy can retain more normal brain tissue and achieve better results.