Li Yu-Hui, Li Dong-Sheng, Wang Mei-Qing, Zhao Kai, Gao Bu-Lang
Department of Neurosurgery, Shijiazhuang People's Hospital, Xian Jiaotong University, 365 South Jianhua Street, Shijiazhuang, Hebei Province 050030, China.
Transl Neurosci. 2020 Oct 20;11(1):380-390. doi: 10.1515/tnsci-2020-0145. eCollection 2020.
To investigate the effect and medical imaging of modified hemispherectomy on patients with infantile hemiparesis and medically refractory epilepsy.
Forty-three patients with infantile hemiparesis and refractory epilepsy who underwent hemispherectomy were enrolled. The treatment effect and medical imaging were analyzed.
Anatomical hemispherectomy was successfully performed in all patients (100%). In all patients, the muscular tension decreased and the contracted limbs relaxed. In the pathological examination of the resected brain tissue, secondary cicatricial gyri with concomitant cortical dysplasia was present in 36 cases and polycerebellar gyrus malformation and porencephalia in the other 7 cases. Followed up for 7-15 years (mean 11.3), all patients were alive without a long-term sequela. Epilepsy was satisfactorily controlled, with complete seizure relief in 39 cases (91%) classified as Engel I and basic control in the other 4 (9%) defined as Engel II. The posthemispherectomy medical imaging demonstrated that the intracranial space on the operative side shrank, and the healthy cerebral hemisphere shifted markedly toward the hemispherectomy side, with expanded lateral ventricle on the healthy side and thickened skull and enlarged frontal sinus on the operative side. After 4-5 years, the intracranial space on the operative side disappeared in 75% of the patients, demonstrating enlarged cerebral peduncle on the healthy side.
Further modified hemispherectomy in patients with infantile hemiparesis and medically refractory epilepsy demonstrated markedly ameliorated effects on epilepsy control and the prevention of superficial cerebral hemosiderosis in the long-term follow-up.
探讨改良大脑半球切除术对小儿偏瘫伴药物难治性癫痫患者的疗效及医学影像学表现。
纳入43例行大脑半球切除术的小儿偏瘫伴难治性癫痫患者，分析其治疗效果及医学影像学表现。
所有患者（100%）均成功实施了解剖性大脑半球切除术。所有患者肌张力均降低，挛缩肢体松弛。切除脑组织的病理检查显示，36例存在继发性瘢痕性脑回伴皮质发育异常，另7例存在多小脑回畸形和脑穿通畸形。随访7至15年（平均11.3年），所有患者均存活，无长期后遗症。癫痫得到满意控制，39例（91%）发作完全缓解，属于恩格尔Ⅰ级，另4例（9%）基本控制，定义为恩格尔Ⅱ级。大脑半球切除术后的医学影像学显示，手术侧颅内空间缩小，健侧大脑半球明显向大脑半球切除侧移位，健侧侧脑室扩大，手术侧颅骨增厚、额窦增大。4至5年后，75%的患者手术侧颅内空间消失，健侧大脑脚增粗。
小儿偏瘫伴药物难治性癫痫患者进一步行改良大脑半球切除术，在长期随访中对癫痫控制及预防浅表性脑铁沉积症有显著改善作用。
