收稿日期:2006-06-13作者单位:710038西安第四军医大学唐都医院神经外科;第四军医大学功能性脑疾病研究所·论著·颅内蛛网膜囊肿伴发癫痫的手术治疗姚庆和张华井晓荣李波王凤鹿高国栋[摘要]目的通过对37例颅内蛛网膜囊肿(intracranialarachnoidcyst,IAC)伴发癫痫患者手术治疗情况的回顾分析,以期对此类患者手术方法的选择提供依据。方法25例患者归为囊肿手术组,方法有囊肿壁切除术、囊肿2腹腔分流术和囊肿造瘘术;12例患者归为癫痫手术组,行囊肿壁切除术同时,切除囊肿周围萎缩变性致痫脑组织,如果患者残存颞叶内侧及杏仁核、海马结构,也予以切除,如囊肿周围邻近功能区,则通过体感诱发电位确定中央沟后于功能区行多处软膜下横切术,必要时行脑皮质离断术和胼胝体切开术,12例均行术中皮层脑电图监测。结果术后37例患者中6例囊肿消失,17例减小,14例无变化,两组相比无显著性差异;囊肿手术组2例无发作,8例改善,15例无效,手术总有效率40%;癫痫手术组7例无发作,3例改善,2例无效,手术总有效率83.3%,两组相比有显著性差异(P<0.05)。结论IAC伴发癫痫患者术前进行癫痫灶的确认,术中行囊肿壁切除术同时切除癫痫灶,大大提高IAC伴发癫痫的手术疗效。[关键词]癫痫;蛛网膜囊肿;手术中图分类号:R742.1文献标识码:A文章编号:1008-2425(2007)01-0015-04SurgicaltreatmentofintracranialarachnoidcystwithepilepsyYaoQinghe,ZhangHua,JingXiaorong,etal.DepartmentofNeurosurgery,InstituteforFunctionalBrainDisorders,TangduHospital,FouthMilitaryMedicalUniversiry,Xi’an,Shanxi,710038[Abstract]ObjectiveTostudythesurgicaltreatmentofintracranialarachnoidcystwithepilepsybyreviewing37patients.MethodsThecyst2groupincluded25patientswhoweretrea2tedbyresectionofthearachnoidcystorcysto2peritonealshuntorcystostomy,Theanother12pa2tientswerenamedepilepsy2group,whoweretreatednotonlybyresectionofthearachnoidcyst,butalsobyresectionoftheepileptiformtissuesaroundthearachnoidcyst,oramygdalaandhippo2campusandmesialtemporallobe.Ifepileptogeniczonelocatedineloquentareas,soproformedmultiplesubpialtransectionafterlocatingcentralsulcusbysomatosensoryevokedpotential.Focalcortexdisconnectionorcorpuscallosotomywasperformedifitwasnecessary.All12patientsweremonitoredbyelectrocorticograminoperation.ResultsInthe37patients,intracranialarachnoidcystsweredisappearedin6patientsanddeflatedin17patientsandunchangedin14patientsafteroperation.Thereisnosignificantdifferenceintwogroups.In25patientsofcyst2group,2patientsgotsizurefreeand8patientsgotsizurereducedand15patientsremainedunchanged.Ontheotherhand,In12patientsofepilepsy2group,7patientsgotsizurefreeand3patientsgotsizurereducedand2patientsremainedunchanged.Thereisasignificantdifferenceintwogroups(P<0.05).ConclusionWithlocatingepileptogeniczonepreoperationandresectionitaftertheresectionofintracranialarachnoidcystinoperation,thesurgicaleffectshouldbeobviouslyincreasedintreat2mentofintracranialarachnoidcystwithepilepsy.[Keywords]Epilepsy;Arachnoidcyst;Surgery51立体定向和功能性神经外科杂志2007年第20卷第1期ChinJStereotactFunctNeurosurg,Feb.2007,Vol.20,No.1颅内蛛网膜囊肿(intracranialarachnoidcyst,IAC)是临床常见疾病,有原发与继发两种,IAC患者常伴有头痛、头晕、癫痫发作等临床表现,目前主张手术治疗,但对手术方法的选择并不一致,特别是对IAC伴发癫痫的患者,如何进行手术治疗并最大程度的控制癫痫发作是治疗的关键,我们对1995年1月至2005年1月我院手术治疗的37例IAC伴发癫痫患者手术治疗的情况进行临床分析,以期对此类患者的手术治疗方法的选择提供依据。资料与方法1.一般情况37例患者中男性23例,女性14例,男女比例为1.64:1,年龄3～35岁,平均14.8岁,癫痫病程1年至22年,平均30.8个月,入院前应用抗癫痫药物治疗时间10个月至20年,平均用药时间27.2...
