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目的探讨难治性癫痫的外科治疗方法并评价手术效果。方法对236例难治性癫痫患者进行术前综合评估,确定致痫灶的起源,采用个体化原则灵活运用各种微创神经外科技术(显微神经外科技术、立体定向技术、神经导航技术、功能性神经导航技术等)并配合术中神经电生理监测来切除致痫灶。结果236例难治性癫痫患者中,手术后癫痫完全消失161例(68.2%),显著改善39例(16.5%),良好13例(5.5%),效差15例(6.4%),无效8例(3.4%),没有死亡等严重并发症;28例位于重要功能区的难治性癫痫患者,手术后78.6%的患者癫痫完全消失,没有明显的运动、感觉、语言和视觉功能障碍加重。结论对于难治性癫痫,术前应综合评估,准确定位致痫灶,然后根据个体化原则选用不同的手术方式进行治疗;而采用功能性磁共振导航结合皮层电极描记来切除位于重要功能区的致痫灶,在控制或减少癫痫发作的同时,能最大限度的保护病人的运动、感觉、语言、视觉等神经功能。
Objective To investigate the surgical treatment of refractory epilepsy and evaluate the effect of surgery. Methods A total of 236 patients with intractable epilepsy were evaluated preoperatively to determine the origin of the epileptogenic focus. Various minimally invasive neurosurgical techniques (microsurgical neurosurgery, stereotactic technique, neural navigation technique, Functional neural navigation technology, etc.) and with intraoperative electrophysiological monitoring to remove epileptogenic lesions. Results In 236 patients with intractable epilepsy, there were 161 cases (68.2%) of epilepsy disappeared completely after surgery, 39 cases (16.5%) were significantly improved, 13 cases (5.5%) were good, 15 cases (6.4% (3.4%) had no serious complications such as death. Twenty-eight patients with intractable epilepsy were found to be in an important functional area. After the operation, 78.6% of the patients completely disappeared without obvious motor, sensory, language and visual dysfunction. Conclusions For refractory epilepsy, preoperative evaluation should be made to accurately locate the epileptogenic zone and then use different surgical methods according to the principle of individualization. Functional magnetic resonance navigation combined with cortical electrode stenography should be used to excise the important functional areas Epileptogenic lesions, in the control or reduce seizures at the same time, to maximize the protection of the patient’s motor, sensory, language, visual and other neurological functions.