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目的 对40例小儿顽固性癫痫施行多处软脑膜下横切术(MSTs)作回顾性分析。方法 40例小儿经MRI/CT检查证实有病变,其分布如下:中央前回15例;中央后回5例;双侧枕叶视皮质5例;Broca区13例;Wernicke区(角回)2 例,所有病变测量均为小于3cm的小病灶。视频EEG/24h EEG检查证实有相应病变的异常放电。全部患儿在全麻下行显微手术,作病变切除及病变周围的致痫灶多处软脑膜下横切术。结果 术后中央前后回病变20 例病理证实为星形细胞瘤I级18例,海绵状血管瘤2例;双侧枕叶病变5例,病理证实为穿通性脑囊肿1 例,神经节细胞瘤3 例,星形细胞胶质增生1例;Broca及Wernicke区/回15例,病理证实为星形细胞胶质增生6 例,皮质发育不良7例,错构瘤2例。手术并发症:1 例帽状腱膜下积液及1 例脑内血肿,手术后10 d消失或改善。经1 ~2年随访,25例(62.5%)再无癫痫发作(Engel class I级);12 例(30%)仍有癫痫发作,但发作程度及频率明显减少或轻微(Engel class Ⅱ级)。结论 MSTs对儿童顽固性癫痫是一种有效的手术,特别是辅助于病变的显微手术时,MSTs是可取的。
Objective To retrospectively analyze 40 pediatric intractable epilepsy patients undergoing multiple subdural transection (MSTs). Methods 40 cases of children confirmed by MRI / CT examination of lesions, the distribution is as follows: 15 cases of central anterior back; 5 cases of central back; 5 cases of bilateral occipital cortex; 13 cases of Broca area; Wernicke District , All lesions were less than 3cm small lesions. Video EEG / 24h EEG examination confirmed the abnormal discharge of the corresponding lesion. All children underwent microsurgery under general anesthesia, resection lesions and lesions around the epileptogenic multi-subdural transection. Results The pathological changes of 20 cases of pathological changes in the central and postoperative patients were grade I in 18 cases, cavernous hemangiomas in 2 cases, bilateral occipital lobe in 5 cases, pathological findings of penetrating cyst in 1 case, ganglioneurocytoma 3 cases, 1 case of astrocytic hyperplasia; 15 cases of Broca and Wernicke area / back, pathological confirmed as astrocyte glial hyperplasia in 6 cases, cortical dysplasia in 7 cases and hamartoma in 2 cases. Surgical complications: 1 case of subgaleal effusion and 1 case of intracerebral hematoma, 10 days after surgery disappeared or improved. Twenty-five patients (62.5%) had seizures (Engel class I) after 1-2 years of follow-up. Seizure still occurred in 12 patients (30%), but seizure severity and frequency were significantly reduced or mild (Engel class II) . Conclusions MSTs are an effective surgical treatment for intractable epilepsy in children, especially when assisted by microsurgery for lesions. MSTs are preferable.