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1、立體定向和功能性神經(jīng)外科雜志2007年第20卷第1期ChinJStereotactFunctNeurosurg,Feb.2007,Vol.20,No.115·論著·顱內(nèi)蛛網(wǎng)膜囊腫伴發(fā)癲癇的手術治療姚慶和張華井曉榮李波王鳳鹿高國棟[摘要]目的通過對37例顱內(nèi)蛛網(wǎng)膜囊腫(intracranialarachnoidcyst,IAC)伴發(fā)癲癇患者手術治療情況的回顧分析,以期對此類患者手術方法的選擇提供依據(jù)。方法25例患者歸為囊腫手術組,方法有囊腫壁切除術、囊腫2腹腔分流術和囊腫造瘺術;12例患者歸為癲癇手術組,行囊腫壁切除術
2、同時,切除囊腫周圍萎縮變性致癇腦組織,如果患者殘存顳葉內(nèi)側(cè)及杏仁核、海馬結構,也予以切除,如囊腫周圍鄰近功能區(qū),則通過體感誘發(fā)電位確定中央溝后于功能區(qū)行多處軟膜下橫切術,必要時行腦皮質(zhì)離斷術和胼胝體切開術,12例均行術中皮層腦電圖監(jiān)測。結果術后37例患者中6例囊腫消失,17例減小,14例無變化,兩組相比無顯著性差異;囊腫手術組2例無發(fā)作,8例改善,15例無效,手術總有效率40%;癲癇手術組7例無發(fā)作,3例改善,2例無效,手術總有效率83.3%,兩組相比有顯著性差異(P<0.05)。結論IAC伴發(fā)癲癇患者術前進行癲癇灶
3、的確認,術中行囊腫壁切除術同時切除癲癇灶,大大提高IAC伴發(fā)癲癇的手術療效。[關鍵詞]癲癇;蛛網(wǎng)膜囊腫;手術中圖分類號:R742.1文獻標識碼:A文章編號:1008-2425(2007)01-0015-04SurgicaltreatmentofintracranialarachnoidcystwithepilepsyYaoQinghe,ZhangHua,JingXiaorong,etal.DepartmentofNeurosurgery,InstituteforFunctionalBrainDisorders,Tan
4、gduHospital,FouthMilitaryMedicalUniversiry,Xi'an,Shanxi,710038[Abstract]ObjectiveTostudythesurgicaltreatmentofintracranialarachnoidcystwithepilepsybyreviewing37patients.MethodsThecyst2groupincluded25patientswhoweretrea2tedbyresectionofthearachnoidcystorcysto2pe
5、ritonealshuntorcystostomy,Theanother12pa2tientswerenamedepilepsy2group,whoweretreatednotonlybyresectionofthearachnoidcyst,butalsobyresectionoftheepileptiformtissuesaroundthearachnoidcyst,oramygdalaandhippo2campusandmesialtemporallobe.Ifepileptogeniczonelocatedi
6、neloquentareas,soproformedmultiplesubpialtransectionafterlocatingcentralsulcusbysomatosensoryevokedpotential.Focalcortexdisconnectionorcorpuscallosotomywasperformedifitwasnecessary.All12patientsweremonitoredbyelectrocorticograminoperation.ResultsInthe37patients
7、,intracranialarachnoidcystsweredisappearedin6patientsanddeflatedin17patientsandunchangedin14patientsafteroperation.Thereisnosignificantdifferenceintwogroups.In25patientsofcyst2group,2patientsgotsizurefreeand8patientsgotsizurereducedand15patientsremainedunchange
8、d.Ontheotherhand,In12patientsofepilepsy2group,7patientsgotsizurefreeand3patientsgotsizurereducedand2patientsremainedunchanged.Thereisasignificantdifferenceintwogroups(P<0.05
