摘要目的 探讨顽固性癫痫伴偏瘫患者应用改良的大脑半球切除手术治疗前后的影像学表现(CT、MRI)及其临床意义. 方法 回顾性收集石家庄市第一医院神经外科自1996年至2010年收治的29例伴有偏瘫的顽固性癫痫患者的临床资料,患者均行改良的大脑半球切除术治疗,结合脑电图资料对其影像学表现进行分析总结. 结果 患者术前影像学资料均显示一侧半球广泛病变;健侧大脑脚增粗,患侧萎缩.手术均切除病变侧半球脑组织.术后显示健侧大脑半球向患侧移位,患侧额窦变大,颅骨增厚,手术残腔明显缩小.29例患者术后随访2～15年,Engel分级达1～2级者27例(93.1％),3级者2例(6.9％).所有患者偏瘫未加重,无失语发生,且均无远期合并症发生.结论 影像学表现在伴有偏瘫的顽固性癫痫定位方面可能较脑电图更有价值,同时大脑半球切除手术前后影像学改变也能解释手术后硬膜下腔明显缩小、远期合并症发生减少的原因.

abstractsObjective To explore the imaging characteristics of hemiplegic patients with intractable epilepsy before and after modified hemispherectomy and their clinical significances.Methods The clinical data of 29 patients,admitted to and underwent hemispherectomy in our hospital from 1996 to 2010,were retrospectively analyzed.The characteristics ofpre-and post-surgical imaging of these patients were analyzed.Results Pre-surgical imaging showed that the crus cerebri of healthy lateral was enlarged for compensation and another lateral was atrophy with illed hemisphere.Hemispherectomy succeed in all the patients on the illed hemisphere; post-surgical imaging showed that operative cavity was reduced through healthy hemisphere shiftting to operative lateral,frontal sinus enlarging and skull becoming thickness.Follow-up was performed for 2-15 years; the disturbance of the nervous function was not worsened and there was no late complication in all the patients; Engel grading showed grade Ⅰ and Ⅱin 93.1％ patients and grade Ⅲ in 6.9％.Conclusion The CT/MR imaging is more valuable in localizing of the lesions as compared with EEG; the imaging changes before and after hemispherectomy can explain the shrunk cacity and few late complications.