Tinuper P, Andermann F, Villemure J G, Rasmussen T B, Quesney L F
Montreal Neurological Hospital and Institute, McGill University, Quebec, Canada.
Ann Neurol. 1988 Jul;24(1):27-34. doi: 10.1002/ana.410240107.
Hemispherectomy is effective in arresting seizures associated with maximal or near maximal hemiparesis. This procedure, however, carries an unacceptable 33% risk of late complications due to cerebral hemosiderosis. Anatomically partial but functionally complete hemispherectomy was devised to avoid these complications. The frontal or occipital lobes, or both, were left in place with the blood supply intact but with connections to commissures and brainstem divided. The central strip and parietal and temporal lobes were removed. Twenty patients were so treated with a follow-up of 4 to 13 years (average, 7.3 years) in 14. Ten of these are seizure free, 1 had a single nocturnal seizure, 1 had occasional focal twitching, and 2 had a worthwhile but lesser reduction in the seizure tendency. None has developed cerebral hemosiderosis, to date. In appropriately selected patients, functional hemispherectomy is an effective procedure preferable to callosotomy or to partial hemispherectomy. When there is no independent ictal discharge from the opposite hemisphere, arrest of seizures may be expected, leading to improvement in cognitive functioning (mean increase, 10 IQ points), social behavior, and a reduction in or discontinuation of anticonvulsant medication. In these patients, gait and hand use remain unchanged.
大脑半球切除术对于控制与严重或近乎严重偏瘫相关的癫痫发作有效。然而，该手术因脑铁沉积症而存在33%的晚期并发症风险，这是不可接受的。为避免这些并发症，设计了解剖学上部分但功能上完整的大脑半球切除术。保留额叶或枕叶，或两者均保留，其血供完好，但与连合和脑干的连接被切断。切除中央沟以及顶叶和颞叶。20例患者接受了这种治疗，其中14例随访了4至13年（平均7.3年）。这些患者中，10例无癫痫发作，1例夜间有一次发作，1例偶尔有局灶性抽搐，2例癫痫发作倾向有一定程度但较轻微的减轻。迄今为止，无一例发生脑铁沉积症。对于经过适当选择的患者，功能性大脑半球切除术是一种有效的手术方法，优于胼胝体切开术或部分大脑半球切除术。当对侧半球没有独立的发作性放电时，预计癫痫发作会得到控制，从而导致认知功能改善（平均智商提高10分）、社会行为改善以及抗惊厥药物减少或停用。在这些患者中，步态和手部功能保持不变。
