Department of Neurosurgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA.
Department of Neurosurgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA.
Epilepsy Behav. 2019 Feb;91:13-19. doi: 10.1016/j.yebeh.2018.06.036. Epub 2018 Jul 23.
Surgical resection of the epileptogenic zone within the frontal lobe can be a very effective treatment for medically refractory epilepsy originating from this area. While much of the frontal lobe consists of highly eloquent tissue, surgery is not necessarily contraindicated as long as the epileptogenic zone is well-localized and the tissue resected is limited. Resection of the primary motor cortex was described by Victor Horsley in the 19th century and was used frequently in the early 20th century for a variety of neurological disorders including epilepsy; improvements in surgical techniques and mapping has led to a resurgence of its use in the past few decades. Although many surgeons are hesitant to resect tissue adjacent to the primary hand area based on fears of new motor deficits, there is extensive evidence that focal resections are well-tolerated over the long-term with residual weakness that is fairly mild: some patients experience postoperative weakness, including hemiparesis, but a stereotypical recovery of strength from proximal to distal muscles occurs over months, and only one quarter will have a permanent neurologic deficit, usually consisting of difficulty with fine motor movements. The main alternative to surgical resection is subpial transection, characterized by a small decrease in postoperative deficits and significantly worse seizure outcomes. The treatment of patients with seizures originating from this region requires a solid understanding of the structural and functional anatomy of the frontal lobe.
额叶癫痫灶的手术切除是一种非常有效的治疗方法，适用于起源于该区域的药物难治性癫痫。虽然额叶的大部分区域都是高度复杂的组织，但只要癫痫灶定位明确，切除的组织有限，手术就不一定是禁忌。19 世纪，Victor Horsley 就描述了切除大脑初级运动皮层的手术，在 20 世纪早期，这种手术经常用于治疗各种神经疾病，包括癫痫；随着手术技术和映射技术的进步，在过去几十年中，这种手术的应用又重新兴起。尽管许多外科医生因为担心新的运动缺陷而不愿切除初级手区附近的组织，但有大量证据表明，长期以来，焦点切除术是可以耐受的，残留的无力是相当轻微的：一些患者术后会出现无力，包括偏瘫，但从近端到远端肌肉的力量会在几个月内逐渐恢复，只有四分之一的患者会有永久性的神经功能缺损，通常表现为精细运动的困难。手术切除的主要替代方法是软膜下横断术，其术后缺陷的减少较小，但癫痫发作的结果明显更差。对于起源于该区域的癫痫患者的治疗，需要对额叶的结构和功能解剖有一个坚实的理解。
