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1、伽玛刀治疗顽固性癫痫(附166例分析)作者:徐波涛梁军潮王伟民覃子衡单位:中国人民解放军广州军区广州总医院神经外科,广东广州510010【摘耍】目的探讨伽玛刀治疗顽固性癫痫的可行性。方法回顾性分析伽玛刀治疗166例顽固性癫痫的结果,根据癫痫发作特点、脑电图、PET-CT或脑磁图、CT或MRI进行致痫灶定位。应用Lekscll伽玛刀治疗,单纯以致痫灶为靶点时,边缘剂量10-12Gy,等中心曲线40%~60%。需加照射同侧杏仁核和海马时,边缘剂量16-20Gy,等中心
2、11
3、线40%〜50%。结果随访6〜96个刀,平均58.5个月。Wies
4、er癫痫外科手术疗效分级:I和II级视作治愈,本纽30.0%~37.6%;III和IV级视作治疗有效,40.6〜53.1%;V和VI级视作治疗无效,15.7%〜21.8%。发作频率术前为(5.1±2.9)次/月,术后12个月降至(1.1±0.8)次/月,随访结束时降至0.9次/月左右。主要并发症为放射性脑水肿,发牛率5.4%,经对症治疗后均能缓解。结论伽玛刀治疗顽固性癫痫效果良好,无严垂并发症,可以作为顽固性攧痫外科治疗的一种选择。【关键词】放射外科手术癫痫立体定位技术StereotacticGammakni
5、feforintractableepilepsy:reportof166casesXUBotao,LIANGJunchao,WANGWeimin,etalDepartmentofNeurosurgery,GuangzhouGeneralHospitalofGuangzhouMilitaiyAreaCommand,Guangzhou510010,ChinaAbstract:ObjectiveToevaluatethefeasibilityofstereotacticGammaknifeforintractableepilepsy.Meth
6、odsThetreatmentoutcomesof166patientswithintractableepilepsytreatedbyLeksellGammaKnifewereretrospectivelyanalyzed・Theepileptogenicfocuswaslocalizedbycharacteristicsofepilepticseizure,EEGPET-CTormagneticencephalography,CTorMRI.Marginaldoseof10-12Gytoisodoselineof40%-60%was
7、managedwhentargetwaspointedtotheepileptogenicfocus,and16-20Gyto40%-50%wasmanagedtothehomolateralamygdalaandhippocampusifnecessary.ResultsThefollow-uptimewere6-96months,averaging58.5months.30%-37.6%wasclassifiedasWiesergrades1andII,whichwereregardedascured,40.6%-53.1%asgr
8、adesIIIandIV,aseffective,and15.7%-27.8%asgradesVandVI,asineffective・Theseizurefrequencydeclinedfrom(5.1±2.9)timespermonthbeforeGammaknifetreatmentto(1」±0.8)timespermonth12monthsaftertreatment,and0.9permonthtilltheendofthefollow-up.Themaincomplicationwasradi
9、ation-inducedcerebraledemawithanincidencerateof5.4%,andrelievedaftersymptomatictreatment.ConclusionGammaknifeiseffectiveforntractableepilepsywithnoseriouscomplications,thusbeingregardedasachoiceofsurgicaltreatmentforintractableepilepsy・Keywords:radiosurgery;epilepsy;ster
10、eotaxictechniques顽固性癫痫有多种外科治疗方式,多能取得一定效果。最近20年,神经外科更生开始尝试应用伽玛刀治疗癫痫,但报道较少。从1995年9丿J〜2005年12月,我们应用Leksell