Patil A A, Andrews R V, Torkelson R
Epilepsy Care Center, Immanuel Medical Center, Omaha, Nebraska, USA.
Surg Neurol. 1997 Jan;47(1):72-7; discussion 77-8. doi: 10.1016/s0090-3019(96)00389-8.
Patients with multilobar or bihemispheric seizure foci (MLBHSF) are generally not considered candidates for major resective surgery because of the high risk of complications. A combination of relatively less invasive surgical procedures were used to treat 19 patients with intractable seizures with MLBHSF.
Epileptogenic areas were identified via standard techniques. Locations of the seizure foci were in two lobes of a hemisphere in 11 patients, three lobes of a hemisphere in four patients, four lobes of a hemisphere in one patient, and both hemispheres in three patients. All 19 patients had multiple subpial transections; in addition, seven patients had small topectomies and nine patients had amygdala hippocampotomies.
The longest follow-up is 54 months and the median for follow-up is 33 months. Nine patients (47%) are either free of seizures or have only rare seizures; eight patients (41%) have greater than 90% reduction in seizure frequency; one patient (6%) has complete cessation of myoclonic seizures and secondary generalization, and greater than 50% reduction in partial complex seizures; and one patient (6%) has greater than 50% reduction in seizure frequency. There were no permanent operative complications.
Though the follow-up is relatively short and the number of patients is small, these results are encouraging, because the majority of patients in this group were poor surgical candidates.
多叶或双侧半球癫痫灶（MLBHSF）患者由于并发症风险高，通常不被视为大型切除手术的候选者。采用相对微创的手术方法组合治疗了19例患有MLBHSF的顽固性癫痫患者。
通过标准技术确定致痫区域。癫痫灶位于一个半球的两个叶的患者有11例，位于一个半球的三个叶的患者有4例，位于一个半球的四个叶的患者有1例，位于双侧半球的患者有3例。所有19例患者均进行了多处软膜下横切术；此外，7例患者进行了小范围的脑叶切除术，9例患者进行了杏仁核海马切除术。
最长随访时间为54个月，随访中位数为33个月。9例患者（47%）无癫痫发作或仅有罕见癫痫发作；8例患者（41%）癫痫发作频率降低超过90%；1例患者（6%）肌阵挛发作和继发性全身性发作完全停止，部分复杂性发作减少超过50%；1例患者（6%）癫痫发作频率降低超过50%。无永久性手术并发症。
尽管随访时间相对较短且患者数量较少，但这些结果令人鼓舞，因为该组中的大多数患者并非手术的理想候选者。
