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癫痫是危害较大的神经系统常见病,其中约30%~40%属于难治性癫痫,近年来随着术前评估及外科手术技巧不断改进,特别是显微外科技术的应用,外科治疗尤其是对颞叶内侧癫痫的治疗疗效满意。癫痫的术前评估至关重要,手术效果与术前致痫灶定位准确与否密切相关。癫痫术前评估包括非侵袭性评估(I期)和侵袭性评估(II期),随着新的诊断技术的飞速发展,术前评估通过脑电图、脑磁图、CT、MRI、磁共振波谱、功能MRI成像、单光子发射计算机断层扫描和正电子发射计算机断层扫描等以确定病人致痫灶。癫痫手术方式主要有颞叶切除术、选择性杏仁核海马切除术、胼胝体切开术、大脑半球切除术等。本文就癫痫手术适应证、术前评估、手术方式等予以综述。
Epilepsy is a more damaging neurological common disease, of which about 30% to 40% are refractory epilepsy, in recent years with the preoperative assessment and surgical techniques continue to improve, especially the application of microsurgery, surgical treatment, especially Is the treatment of medial temporal lobe epilepsy with satisfactory results. Preoperative assessment of epilepsy is crucial, and the effect of surgery is closely related to the accuracy of preoperative localization of the epileptogenic focus. Preoperative evaluation of epilepsy includes non-invasive evaluation (stage I) and invasive evaluation (stage II). With the rapid development of new diagnostic techniques, preoperative evaluation is performed by EEG, magnetoencephalography, CT, MRI, magnetic resonance Spectroscopy, functional MRI imaging, single photon emission computed tomography and positron emission computed tomography to determine the patient’s epileptogenic zone. Epilepsy surgical methods are mainly temporal lobe resection, selective amygdala hippocampus resection, corpus callosum incision, hemispherectomy and so on. This article indications for epilepsy surgery, preoperative evaluation, surgical methods are reviewed.