| Objective: we explore the surgical curative effect of intractable focalepilepsy.Method: The clinical data of15post-operative and follow-up patientswho MRI showed focal disease and through strict preoperative assessment afterepileptic surgery were summarized to evaluate the results of operation. Thediagnosis of intractable focal epilepsy was based on the following criteria:1.patients still could not control seizures and were affected daily work and lifethrough the treatment of antiepileptic drugs more than two years.2.MRI showedfocal disease, more than one lesions was out of our research.15cases werechoosed,11were male and4were female. The ratio of male to female was2.75:1.Age at presentation of intractable focal epilepsy ranged from5years to43years, and the average age was25years. The clinical course of thesepatients were more than2years and it was not good by the treatment of oralantiepileptic drugs. It was not obvious positive signs of nervous systembetween interictal phases in the hospital. All patients were performed head CT,and the examination of American general GE_SIGNA1.5T MRI, the sequenceof which were T1-weighted axial, T2-weighted axial and T2-FLAIR coronaryscan. The results of imaging examination showed single lesion (no otherabnormal morphology).These patients were used the American Nicoletone32-guided video-brain electrical monitoring system for double video-brainelectrical monitoring, and had a breath, closed and opened your eyes, flashstimulation tests. The system had a complete record of electro-encephalogramin24hours, and analysis the change of electrical signals in ictal and interictalphases. We could find the position of the epileptogenic zone combining withthe preoperative results of head CT, MRI and EEG. We could find the area of epileptogenic zone roughly in the epidural mater after craniotomy, monitoringthe cortical discharge area with a bar electrode when openning the cerebraldural mater. According to the situation of epileptic discharge we coulddetermine the position of the epileptogenic zone. All patients weredrug-resistent focal epilepsy, whose surgical indications were clear by thepreoperative assessment. We have not carried out resections of theepileptogenic zone until got the agreement of the patients and their familymembers. In operation we further evaluated the situation of surgical resectionwith real-time brain electrical monitoring. We have carried out the cortexthermocoagulation around the epileptogenic zone and compared the results ofbrain electrical monitoring many times until the epileptiform dischargedisappeared during the operation. Our operations included: focal diseaseresection in1case, focal disease resection+cortex thermocoagulationin12cases, focal disease resection+former temporal lobe, hippocampus andamygdala resection in2cases. According to the condition of each patient, wechose different surgical method. The brain tissue which was resected needed tomake a pathological examination.Results:The types of seizure in15patients, CPS and GTCS in8cases, SPS andGTCS in2cases, CPS in2cases, SPS in1case, GTCS in1case, SPS, CPS andGTCS in1case. It is CPS and GTCS that are common types, and GTCS offenoccurred after CPS.Among15patients, TLE in6patients (the mesial type in2cases, thelateral type4cases), frontal lobe epilepsy in4cases, parietal lobe epilepsy in4cases, the temporal and parietal epilepsy in1case. TLE is still a common typein the intractable focal epilepsy.All the pathologic reports of postoperative patients were abnormal,intracranial arachnoid cyst in2cases,3cases of hemangioma,3cases with glioma,1case with meningioma, soften lesions in1case, scar and glial cellhyperplasia in4cases.Among15patients,13patients were Engel â… level,2patients were Engelâ…¡level.Conclusion:1. The result of the operation is good in theses intractable epilepsies withfocal disease in MRI, recommend early surgical treatment.2. The key to surgical treatment for intractable focal epilepsy is theposition of the epileptogenic zone. |
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