摘要目的 探讨大脑半球离断术治疗儿童难治性癫痫的手术方法及疗效.方法 2007年8月至2011年10月北京三博脑科医院进行12例大脑半球离断手术.经侧裂半球离断术1例,经纵裂半球离断并颞叶切除4例,中央区造瘘半球离断并颞叶切除5例,颞叶、岛盖切除岛周半球离断术2例.手术年龄平均7.6岁(2.1 ～11.9岁).结果 术后随访0.5 -4.5年,Engel Ⅰ级10例,EngelⅡ级1例,Engel Ⅲ级1例.术后因离断不完全再次行离断手术1例.术后患者的认知及生活能力较术前提高,无脑积水等严重神经功能损伤及死亡病例.结论 大脑半球离断术治疗儿童半球性难治性癫痫完全缓解率83％ (10/12),手术疗效确定,是治疗儿童半球病变性癫痫的安全、有效的方法.

abstractsObjective To assess the surgical techniques and surgical outcomes of hemispherotomy for children with intractable epilepsy.Methods The authors conducted a retrospective review of clinical,neuropsychological,electroencephalogram ( EEG),imaging data in 12 children with intractable epilepsy who underwent hemispherotomy between August 2007 and October 2011.Of the 12 cases,7 were males and 5 were females.The age of seizure onset was from 0.1 to 10 years ( average 4.2) and disease duration of 0.7 to 7 years ( average 3.3).The surgery was performed between the age of 2.1 and 11.9 years ( average 7.6).One patient underwent trans - sylvian hemispherotomy,4 patients underwent hemispherotomy through an interhemispheric approach and temporal resection,5 hemispherotomy through a central cortex approach and temporal resection,2 peri - insular hemispherotomy and temporal lobe and pars perculairs resection.Results After a mean follow -up of 2.18 years months (range 0.5 -4.5 years),10 patients had seizure free,one patient had Engel Class Ⅱ seizure outcome and one patient had Engel class Ⅲ outcome.1 patient underwent a second surgical procedure due to incomplete disconnections.All of the patients had increases in cognitive abilities and quality of life after the surgery.After the surgery,all of the patients can walk independently,but the fine movements of the hands were lost.Up to now,hydrocephalus and superficial cerebral hemosiderosis were not discovered and no death case in this study.Conclusion Hemispherotomy is a safety and effective epilepsy surgery procedure for children with intractable epilepsy.