Ojemann G A
Appl Neurophysiol. 1983;46(1-4):11-8. doi: 10.1159/000101235.
The therapeutic goal in the neurosurgical treatment of medically intractable epilepsy is complete seizure control, for both biologic and psychosocial reasons. Cortical resections are more likely to accomplish this than other surgical alternatives for epilepsy. Although abnormalities on new imaging techniques (CT, positron emission scanning) aid in identifying the epileptic focus, interictal epileptiform EEG changes remain the main indicator of focal origin of the seizures. Where this is equivocal, direct brain recording of spontaneous seizures with subdural electrodes is of value in identifying the side and lobe of seizure onset. The cortical resection is then tailored by the extent of the interictal electrocorticographic abnormalities and functional identification of essential areas such as those for language, using an electrical stimulation mapping technique, under local anesthesia. With this approach, half of the patients with temporal lobe foci are seizure-free since the time of operation, over two-thirds become so with time, and over three-quarters have at least very major reductions in seizure frequency.
出于生物学和社会心理方面的原因，药物难治性癫痫的神经外科治疗目标是完全控制癫痫发作。与其他癫痫手术方法相比，皮质切除术更有可能实现这一目标。尽管新的成像技术（CT、正电子发射扫描）显示的异常有助于确定癫痫病灶，但发作间期癫痫样脑电图变化仍然是癫痫发作局灶性起源的主要指标。在情况不明确时，使用硬膜下电极对自发性癫痫发作进行直接脑记录，对于确定癫痫发作起始的侧别和脑叶具有重要价值。然后，在局部麻醉下，根据发作间期皮质脑电图异常的范围以及对语言等重要区域的功能识别（采用电刺激定位技术）来确定皮质切除术的范围。采用这种方法，一半的颞叶病灶患者术后即刻无癫痫发作，超过三分之二的患者随着时间推移实现无发作，超过四分之三的患者癫痫发作频率至少有非常显著的降低。
