Surgical Treatment And Indications For Drug Refractory Epilepsy And Therapeutic Efficacy

Objective To analyze the preoperative evaluation, surgical approach(resection of epileptic foci, the corpus callosum incision) as well as experience in the treatment of Sturge-Weber syndrome, in addition of the efficacy observation, to provide clinical basis in clinical treatment, and to explore the imaging characteristics and surgical treatment points of Sturge-Weber syndrome. Methods1.Retrospective analysis total60cases with resection surgery of epileptogenic zone from April2008to January2012, in which according to the location of the epileptic foci,18cases of frontal lobe epilepsy, occipital lobe10cases,22cases of temporal lobe,5patients of the hemisphere discharge, and another five cases of patients unable to locate the location of epileptic foci the took pathological foci resection. Of all the60cases, arachnoid cyst four cases, five cases of cortical dysplasia, cortical dysplasia neuroepithelial tumors in10cases, traumatic malacia lesions of eight cases, two cases of heterotopic gray matter disease, brain penetrating malformation1cases, the sturge-weber syndrome three cases, Rusmussen encephalitis in4cases,13cases of cavernous hemangioma,10cases of hippocampal sclerosis.2.114cases with refractory epilepsy, all took two kinds of anti-epileptic drugs and still difficult to control seizures. Imaging and repeated EEG to exclude epileptic foci which can be surgically removed. Patients with seizures often significantly affect their daily lives. Incised the anterior1/2to2/3of the corpus callosum, the degree of incision in most cases by signs and postoperative brain MRI confirmed, all patients were followed up more than1year.3.To analysis3Sturge-Weber syndrome cases(type â… ),2male and1female. Before surgery, every patient undergo CT and MRI scan and VEEG test; and after surgery, followed up for1to2years. Results1. of the60patients with epileptic focus resection, out hospital before and after6months of regular followed up, the EEG results showed that compared with the preoperative epileptic discharge to reduce or completely disappeared, the amplitude decreased significantly, according to the Engel efficacy grading standards:level â… :There was no postoperative attack; grade â…¡: minimal attack; â…¢ level:seizures reduced by75%compared with the preoperative; â…£ level:no significant improvement compared with the preoperative; as the standard, this group of grade â… 40cases,10cases of grade â…¡, four cases of grade â…¢, gradeâ…£ six cases.50cases of Grade â…  and grade â…¡ were clinical cure, four cases of the grade â…¢ called improvement, the cure rate is83.33%, improvement rate is6.67%. Followed up for6months to3years.2. Of114patients,12cases of tonic seizures in patients receive attack disappeared, and another nine cases of seizures reduced by90%; in17cases of atonic seizures,16cases postoperative seizures disappear, one cases of seizure reduction of90%or more; of39cases with tonic clonic seizures,19cases had seizures disappear, eight cases with seizure reduction more than90%;41cases of45patients with atonic and tonic seizures received seizure free, three cases had seizure reduction of90%or more. Attack on the whole completely disappeared about68%, and satisfaction rate is approximately87%(seizure reduction more than90%we called satisfaction).3.In CT scan, all the3patients manifest calcification in brain tissue. Abnormal blood vessels and cerebral atrophy can be displayed in MRI imaging, it can determine the area. Effectiveness of surgery:2patients undergo tempro-occipital craniotomy, and the other patient undergo hemispherectomy. After1to2years follow-up, all patients had epilepsy release. Conclusion1. Symptomatology, long-distance video-EEG(video-electroencephalography, V-the EEG), magnetic resonance imaging(magnetic resonance imaging,MRI), three checks provide a reliable basis for diagnosis and treatment of drug refractory epilepsy; the symptom of epilepsy, imaging and video EEG monitoring accounts for the three elements of preoperative evaluation, if the three means are reciprocal, indications for surgery, of course, is the strongest; of the three means, the result of video-EEG is the most important. If EEG monitoring results match the rest two means, the epilepsy surgery may also be taken; if EEG monitoring results do not match with the rest of two means, then will need further assessment tools to confirm, such as magnetoencephalography, PET, or cortical electrodes to further confirm. As the choice of surgical approach, for tumors with epilepsy, such as glioma, cavernous hemangioma, or arteriovenous malformations, first take the removal of pathological lesions. The effect of the symptomatic epilepsy surgery is mostly good, and EEG monitoring confirmed that the majority of epileptic foci and the pathological lesions are adjacent, the removal of pathological foci play a good therapeutic effect on epilepsy.2. when can not take focal resection, corpus callosum incision is a safe, effective treatment for medically intractable epilepsy. In particular, the effect of falling seizures and secondary generalized seizures types were better, by micromanipulation in the surgery and step-by-step resection, the complications is greatly reduced. Along the test means continuous improved, the detection rate of focal lesions improved, this palliative surgery may be used less and less gradually.3.Sturge-Weber syndrome can be determined by combining clinical manifestion and CT MRI imaging. Surgical therapy should be taken early in patients with epilepsy. The total remove of lesion without adding functional deficient is the only way to release the epilepsy seizure of Sturge-Weber syndrome.