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- 頑性癲癇之手術治療
- 癲癇之神經外科手術治療(兼論癲癇侵入性術前評估與手術)
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- Electrocorticographic Monitoring as an Alternative Tool for the Pre-Surgical Evaluation of Patients with Bi-Temporal Epilepsy
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頁籤選單縮合
題 名 | 頑性癲癇之手術治療=Surgical Treatment of Intractable Epilepsies |
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作 者 | 施養性; | 書刊名 | 癲癇論壇 |
卷 期 | 1:1 1997.03[民86.03] |
頁 次 | 頁27-36 |
分類號 | 416.29 |
關鍵詞 | 頑性癲癇; 卵圓孔電極; 硬膜下電極板; 前顳葉切除術; 胼胝體切開術; Intractable epilepsy; Foramen ovale electrode; Subdural grid electrode; Anterior temporal lobectomy; Corpus callosotomy; |
語 文 | 中文(Chinese) |
中文摘要 | 台北榮民醫神經醫學中心的癲癇外科工作計畫成立於 1987 年8 月。至1996 年7 月,總計有 129 例顳葉切除術,43 例顳葉外切除術、80 例胼胝體切開手術及 2 例大腦半 球切除術。第一階段的術前檢查包括顱外腦電圖、長期腦電圖影像同步監錄 (long-term EEG/video monitoring)、電腦斷層掃描、 核磁共振掃描、單光子斷層掃描、正子斷層掃描 及神經心理學檢查。 第二階段術前檢查包括: (1) 卵圓孔電極 (foramen ovale electrodes) 植入術,應用於 12 例兩側顳葉發作的病人;(2) 術中人體感誘發電位定位運 動感覺皮質及硬膜下電極板 (subdural grid electrode) 植入術,則應用於 7 例顳葉外發 作的病人。 在 98 位已追蹤了 24 個月接受顳葉切除術的成人病患中,有 78 位 (81%) 術 後完全不再發作;10 位 (10%) 偶有發作 (每年少於三次 )。在 25 位已追縱 12 個月胼胝 體切開術的小兒病患中, 7 位 (28 %) 術後不再發作; 10 位 (40%) 發作次數降低超過了 50 %。 總而言之,前顳葉切除術是成人病患在癲癇外科最常見,且最有效手術;小兒病患則胼 胝體切開術為最多。 新的診斷方法如核磁共振頻譜 (magnetic resonance spectroscopy) 對致癲癇病灶之定位有所助益。而顳葉外發作的病人,通常有腦部結構性的異常,硬膜下電 極板可以用來定位致癲癇病灶之範圍並找出腦部重要的功能性皮質。 |
英文摘要 | Purpose Surgical resection of an epileptic focus had been proved to be effective in the management of intractable epilepsy. However,the process of selecting patients for sugery is time-consuming, requiring sequential decisions made by a skilled and disciplined team. The difficulty had been considerably reduced by the advent of modern diagnostic methos, which allow more accurate localization of the epileptogenic foci. Methods The Epilepsy Surgery Program was established at the Neurological Insitute, Veterans General Hosptial-Taipei in August 1987. Potential surgical candidates were enrolled in the phase I study, which included serial electroencephalograms (EEG) , long-term EEG/video monitoring, computed tomogram (CT), magnetic resonance imaging (MRI), single photon emission computed tomogram (SPECT) , positron emission tomogram (PET) and nuropsychological assessment. In the phase Ⅱ study, forman ovale electrodes (FOE) were used in patients with bilateral temporal lobe onset of seizures. Subdural gids implantation with intraoperative localization of the sensorimotor cortex by evoked potentials and subsequenst seizure recording and functional mapping were performed in seven patients with extratemporal lobe seizures. Results We performed 129 anterior temporal lobectomies (ALT), 43 extratemporal resectons, 80 corpus callosotomies, and two hemispherectomies up to July, 1996. After long-term telemetry recording of FOE, nine out of 12 patients revealed clear onset of seizures originatins from one side of the mesial temporal lobe (MTL) and underwent ATL. Intraoperative cortical somatosensory evoked potentials successfully localized the sensorimotor cortex in seven intractable epileptic patients with extratemporal sturctural lesions. Of the seven, the epileptogenic area was clearly defined with intraoperative electrocorticogram (EcoG) in four patients. Subdural grid electrodes were implanted in the other three patients. Their epileptogenic area were defined by using the extraoperative telemtry. Extraoperative functional mapping succesfully localized the sensorimotor cortex. Among 98 temporal lobectomies followed for more than 24 months, 79 (81%) were seizure free and 10 (10%) had only rare seizrues. Conclusions. The most common method of epilepsy surgery for adults was ATL in this series. The semi-invasive technique of FOE recording is especially suitable for the lateralization of bilateral MTL onset of seizures. Those patients with extratemporal lobe seizures usually presented with structural lesions. Subdural grids should be implanted delineation of the epileptogenic area and functional mapping. |
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