Blume H W, Schomer D L
Department of Surgery, Beth Israel Hospital, Harvard Medical School, Boston, Massachusetts 02215.
Annu Rev Med. 1988;39:301-13. doi: 10.1146/annurev.me.39.020188.001505.
Medically intractable epilepsy may be treated successfully with surgery in a high proportion of patients following appropriate clinical and diagnostic evaluation. Recent technical advances provide more precise diagnostic methods, especially for localizing the areas of seizure origin in the cerebral cortex. The excision of epileptogenic cortex remains the main surgical treatment for partial forms of epilepsy, while commissurotomies are appropriate for some patients with a secondary, generalized type of epilepsy. Limited experience with a variety of stereotaxic lesions and the modality of cerebellar stimulation has not yet provided definite evidence of efficacy of these techniques. Following surgical excisions, two thirds of the patients are significantly improved and over one third become seizure free, with morbidity-mortality rates of less than 0.5%.
在经过适当的临床和诊断评估后，很大一部分药物难治性癫痫患者可通过手术成功治疗。近期的技术进步提供了更精确的诊断方法，尤其是用于定位大脑皮层癫痫发作起源区域。切除致痫皮层仍然是部分性癫痫的主要手术治疗方法，而胼胝体切开术适用于一些继发性全身性癫痫患者。对各种立体定向毁损术和小脑刺激方式的经验有限，尚未提供这些技术有效性的确切证据。手术切除后，三分之二的患者有显著改善，超过三分之一的患者不再发作，发病率和死亡率低于0.5%。
