功能性大脑半球切除术治疗儿童半球病变致难治性癫痫24例

摘要

Objective To study the results of functional hemispherectomy for pediatric intractable epilepsy with hemisphere lesions , and to explore the indications of functional hemispherectomy , as well as the prognosis. Methods Twenty-four children with intractable epilepsy caused by hemisphere lesions were included , who underwent functional hemispherectomy. All patients were followed up for 3 ~ 48 months. Results All 24 cases obtained improvement of abnormal behavior , and no significant exacerbation of neurological deficits was observed. During the follow-up, 18 cases were in EngelⅠ(75%), 5 in Engel Ⅱ(21%), and 1 in Engel Ⅰ(4%) respectively. No long-term complication was observed. Conclusion Comprehensive presurgical evaluation is a prerequisite for the surgical treatment of pediatric intractable epilepsy caused by hemisphere lesions. Functional hemispherectomy can effectively control seizures and obviously improve the prognosis.%目的：回顾性分析功能性大脑半球切除术治疗儿童半球病变继发难治性癫痫的临床疗效，探讨儿童半球病变致难治性癫痫采用大脑半球切除术的适应证以及预后。方法：对2009年8月至2013年8月在我院因大脑半球病变致难治性癫痫接受功能性大脑半球切除术的24例患儿进行回顾性分析。术后随访3～48个月。结果：24例患儿中术后无发作达到EngelⅠ级18例（75％），Ⅱ级5例（21％），Ⅲ级1例（4％）。全组患儿术后随访神经功能缺失症状无明显加重，行为异常均得到不同程度改善，无明显并发症。结论：对大脑半球病变伴难治性癫痫的患儿实施全面系统的术前评估是保证手术效果必不可少的一个重要环节，在严格把握适应证的前提下进行功能性大脑半球切除术治疗可以有效控制此类患儿的癫痫发作并明显改善预后。