目的对比分析迷走神经刺激术(vagus nerve stimulation,VNS)与胼胝体切开术(corpus callosotomy,CC)治疗药物难治性癫疒间(drug refractory epilepsy,DRE)的效果及安全性。方法回顾性分析53例DRE病人的临床资料,其中22例行VNS治疗(VNS组...目的对比分析迷走神经刺激术(vagus nerve stimulation,VNS)与胼胝体切开术(corpus callosotomy,CC)治疗药物难治性癫疒间(drug refractory epilepsy,DRE)的效果及安全性。方法回顾性分析53例DRE病人的临床资料,其中22例行VNS治疗(VNS组),31例行CC治疗(CC组),比较两种术式在手术时间、住院时间、费用、术中出血量、安全性、有效性及生活质量量表(quality of life in epilepsy-31,QOLIE-31)评分上的差异。结果与CC组比较,VNS组病人手术时间和住院时间较短,费用较高,术中出血量较少,术后3个月和6个月QOLIE-31评分较高,术后3个月有效率较低(P<0.05)。两组术后6个月有效率和并发症发生率差异无统计学意义(P>0.05)。结论VNS具有手术时间短、出血少、恢复快、术后病人生活质量高等优点,是治疗DRE较理想的手术方式。但早期治疗效果差,治疗总费用较高。展开更多
<strong>Background:</strong> Anterior Corpus Callosotomy is a palliative treatment for drug-resistant generalized or multifocal epilepsy patients where focus excision is not an option for management. Callo...<strong>Background:</strong> Anterior Corpus Callosotomy is a palliative treatment for drug-resistant generalized or multifocal epilepsy patients where focus excision is not an option for management. Callosotomy prevents propagation of epileptic discharge from one cerebral hemisphere to the other. <strong>Objective: </strong>To describe Al-Azhar University Hospitals experience and clinical outcome of Anterior Corpus Callosotomy for management of drug-resistant generalized epilepsy patients as an inexpensive palliative method. <strong>Patients and Methods:</strong> In this study, there are 15 patients admitted to Neurosurgery Department in Al-Azhar University Hospitals with drug-resistant generalized epilepsy. These patients were not candidates for lesionectomy. They were managed by anterior two thirds Corpus Callosotomy between February 2017 and December 2019. They were followed at outpatient clinic for at least 14 months. Clinical outcome regarding seizure control was assessed using Engel classification. <strong>Results:</strong> All 15 patients in this study underwent anterior two thirds corpus callosotomy and followed for at least 14 months. The post-operative improvement of seizure frequency has been evaluated using Engel outcome scale with 12 patients (80%) of the patients becoming Engel class II and 3 patients (20%) becoming Engel class III. Only 3 patients (20%) had minor transient postoperative complications;one patient (6.67%) had contra-lateral lower limb heaviness Grade 4 which was transient, one patient (6.67%) had contra-lateral lower limb Jacksonian focal fits and one patient (6.67%) had behavioral changes for one month. <strong>Conclusion:</strong> Corpus callosotomy is a palliative procedure and inexpensive method for management of patients with intractable focal with generalization and generalized drug-resistant epilepsy who are not suitable for resective surgery and with good outcome.展开更多
目的比较立体定向胼胝体及多靶点联合损毁术(stereotactic multiple target lesion technique,STLT)与主癫痫灶切除加软膜下横灼加胼胝体切开术(epilepsy focal resection combined with multiple subpial transection and corpus callo...目的比较立体定向胼胝体及多靶点联合损毁术(stereotactic multiple target lesion technique,STLT)与主癫痫灶切除加软膜下横灼加胼胝体切开术(epilepsy focal resection combined with multiple subpial transection and corpus callosotomy,ERTC)治疗药物难治性癫癇(drug-refractory epilepsy,RE)的有效性及安全性。方法将作者科室近年来129例致癇灶广泛的RE患者分为两组,其中77例选择STLT治疗,52例选择ERTC治疗,随访6~18个月,分析疗效。结果术后两组术式疗效比较差异无统计学意义(Z=-1.935,P<0.05),行STLT的RE患者控制满意率组(53.2%)明显高于ERTC组(28.8%),术后两组均未发生永久性并发症。结论两种手术方式均是RE的安全有效的治疗方法,STLT手术时间短、微创、定位准确、出血少,ERTC更适合未成年人,成人有短暂并发症风险,但大多能恢复。展开更多
文摘目的对比分析迷走神经刺激术(vagus nerve stimulation,VNS)与胼胝体切开术(corpus callosotomy,CC)治疗药物难治性癫疒间(drug refractory epilepsy,DRE)的效果及安全性。方法回顾性分析53例DRE病人的临床资料,其中22例行VNS治疗(VNS组),31例行CC治疗(CC组),比较两种术式在手术时间、住院时间、费用、术中出血量、安全性、有效性及生活质量量表(quality of life in epilepsy-31,QOLIE-31)评分上的差异。结果与CC组比较,VNS组病人手术时间和住院时间较短,费用较高,术中出血量较少,术后3个月和6个月QOLIE-31评分较高,术后3个月有效率较低(P<0.05)。两组术后6个月有效率和并发症发生率差异无统计学意义(P>0.05)。结论VNS具有手术时间短、出血少、恢复快、术后病人生活质量高等优点,是治疗DRE较理想的手术方式。但早期治疗效果差,治疗总费用较高。
文摘<strong>Background:</strong> Anterior Corpus Callosotomy is a palliative treatment for drug-resistant generalized or multifocal epilepsy patients where focus excision is not an option for management. Callosotomy prevents propagation of epileptic discharge from one cerebral hemisphere to the other. <strong>Objective: </strong>To describe Al-Azhar University Hospitals experience and clinical outcome of Anterior Corpus Callosotomy for management of drug-resistant generalized epilepsy patients as an inexpensive palliative method. <strong>Patients and Methods:</strong> In this study, there are 15 patients admitted to Neurosurgery Department in Al-Azhar University Hospitals with drug-resistant generalized epilepsy. These patients were not candidates for lesionectomy. They were managed by anterior two thirds Corpus Callosotomy between February 2017 and December 2019. They were followed at outpatient clinic for at least 14 months. Clinical outcome regarding seizure control was assessed using Engel classification. <strong>Results:</strong> All 15 patients in this study underwent anterior two thirds corpus callosotomy and followed for at least 14 months. The post-operative improvement of seizure frequency has been evaluated using Engel outcome scale with 12 patients (80%) of the patients becoming Engel class II and 3 patients (20%) becoming Engel class III. Only 3 patients (20%) had minor transient postoperative complications;one patient (6.67%) had contra-lateral lower limb heaviness Grade 4 which was transient, one patient (6.67%) had contra-lateral lower limb Jacksonian focal fits and one patient (6.67%) had behavioral changes for one month. <strong>Conclusion:</strong> Corpus callosotomy is a palliative procedure and inexpensive method for management of patients with intractable focal with generalization and generalized drug-resistant epilepsy who are not suitable for resective surgery and with good outcome.
