Schramm J, Behrens E, Entzian W
Neurosurgical Department, University of Bonn, Germany.
Neurosurgery. 1995 Mar;36(3):509-15; discussion 515-6. doi: 10.1227/00006123-199503000-00010.
An alternative technique for so-called functional hemispherectomy has been developed to be used for the classical indications of hemispherectomy or the various modifications of functional hemispherectomy. The technique entails a smaller trepanation, less operation time, and less blood loss, and it leaves more brain tissue in place as compared with other functional hemispherectomy techniques. It starts with either hippocampectomy alone or with hippocampectomy and anterior temporal lobectomy. After this, deafferentation of the white matter of the temporal, occipital, parietal, and frontal lobe, using either a transcortical transventricular approach along the outline of the lateral ventricle or a sylvian key hole approach, is performed. The technique includes a transventricular callosotomy, and it leaves in place only a small portion of the suprainsular cortex and the insular cortex. However, as one modification, removal of the insular cortex can easily be performed, if necessary, and, as a second modification, the entire transventricular deafferentation can be performed through a sylvian key hole. In this report, the technique is described and the surgical experience for the first 13 patients is outlined. The immediate seizure relief with an average follow-up of 12 months was similar to that for patients with functional hemispherectomy, but the follow-up period for these 13 patients is not long enough to allow definite conclusions concerning long-term control of seizures and long-term complications.
一种用于所谓功能性大脑半球切除术的替代技术已被开发出来，可用于大脑半球切除术的经典适应症或功能性大脑半球切除术的各种改良术式。该技术需要的颅骨钻孔较小，手术时间较短，失血量较少，与其他功能性大脑半球切除术技术相比，它能保留更多的脑组织。它可以从单独的海马切除术开始，也可以从海马切除术和颞叶前部切除术开始。在此之后，使用沿侧脑室轮廓的经皮质经脑室入路或外侧裂锁孔入路，对颞叶、枕叶、顶叶和额叶的白质进行去传入神经手术。该技术包括经脑室胼胝体切开术，仅保留岛叶上皮质和岛叶皮质的一小部分。然而，作为一种改良，如果有必要，可以很容易地切除岛叶皮质；作为第二种改良，可以通过外侧裂锁孔进行整个经脑室去传入神经手术。在本报告中，描述了该技术并概述了前13例患者的手术经验。平均随访12个月时的即刻癫痫缓解情况与功能性大脑半球切除术患者相似，但这13例患者的随访期不够长，无法就癫痫的长期控制和长期并发症得出明确结论。
