Talairach J, Bancaud J, Bonis A, Szikla G, Trottier S, Vignal J P, Chauvel P, Munari C, Chodkievicz J P
Department of Neurosurgery, St. Anne's Hospital, Paris, France.
Adv Neurol. 1992;57:707-32.
We have described our 25 years experience concerning 100 patients operated on for frontal epilepsy. Results show that 55% of patients are practically cured of their seizures and that 76% benefited from cortectomy (reduction of more than 75% of seizures). These results are the worst in the total series of St. Anne. Reasons for success and especially failure were analyzed in detail: 1. SEEG methods gave good indications along three dimensions of the limits and borders of the cortical excision. 2. When clinical semiology and organization of ictal discharges give evidence for rapid bilateral discharge, with involvement of axial musculature and generalized tonic-clonic manifestations, experience shows that it is necessary to combine cortectomy with a section of the adjacent cortico-subcortical fibers of the corona radiata, as if propagation of ictal discharges were impeded if not interrupted by sectioning such fibers and the primary site were incapable of expressing itself clinically. 3. If the characteristics of seizures suggest the quasisimultaneous involvement of the two frontal lobes and the existence of bilateral multifocal epilepsy, we suggest that a systematized anterior callosotomy might lead to useful results. 4. Finally, we propose general criteria for indications and contraindications for surgery.
我们描述了对100例额叶癫痫患者进行手术的25年经验。结果显示，55%的患者癫痫发作基本治愈，76%的患者受益于皮质切除术（癫痫发作减少超过75%）。这些结果在圣安妮医院的整个系列中是最差的。我们详细分析了成功尤其是失败的原因：1. 立体定向脑电图（SEEG）方法在皮质切除范围和边界的三个维度上给出了良好的指示。2. 当临床症状学和发作期放电的组织学表现为快速双侧放电，并累及轴向肌肉组织和全身性强直-阵挛发作时，经验表明，有必要将皮质切除术与切断相邻的放射冠皮质-皮质下纤维相结合，因为如果不切断这些纤维，发作期放电的传播似乎会受到阻碍，原发部位无法在临床上表现出来。3. 如果癫痫发作的特征提示双侧额叶几乎同时受累且存在双侧多灶性癫痫，我们建议进行系统化的前连合切开术可能会取得有益的结果。4. 最后，我们提出了手术适应症和禁忌症的一般标准。
