Periinsular anterior quadrantotomy: technical note.
Periinsular anterior quadrantotomy: technical note.
复制标题
岛周前象限切开术：技术说明。
DOI：
10.3171/2017.8.peds17339
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发表时间：
2017
期刊：
影响因子：
--
通讯作者：
R. Daniel
中科院分区：
文献类型：
--
作者：
G. Cossu;S. Lebon;M. Seeck;E. Pralong;M. Messerer;É. Roulet;R. Daniel
难治性额叶癫痫传统上通过额叶切除术进行治疗。一种离断技术可能会产生相似的癫痫控制效果，同时避免与大脑大面积切除相关的并发症。本研究的目的是描述一种新的额叶选择性离断技术，该技术可用于因涉及一个额叶（运动皮层前方）的致痫灶导致的难治性癫痫病例，且能保留运动功能。除了对该技术的描述外，还介绍了一个示例病例。这种离断手术分为4个步骤：岛叶上窗口、胼胝体前部切开术、额叶内离断和额底离断。对手术的每个步骤都详细分析了功能神经解剖学。进行皮质和皮质下电生理标测以指导这种离断手术并识别功能重要的皮质和完整的神经通路是很重要的。作者描述了一个9岁男孩的病例，该男孩因致痫灶位于右侧额叶而出现难治性癫痫。磁共振成像证实右侧额叶存在局灶性皮质发育不良。进行了岛周前象限离断术（象限切开术）。术后恢复顺利，在3年随访时患者处于Engel癫痫发作结果I级。随访期间观察到认知能力有显著提高。因此，当致痫灶位于一个额叶时，岛周前象限切开术可能是一种有效治疗难治性癫痫同时保留残余运动功能的安全技术。
Refractory frontal lobe epilepsy has been traditionally treated through a frontal lobectomy. A disconnective technique may allow similar seizure outcomes while avoiding the complications associated with large brain resections. The aim of this study was to describe a new technique of selective disconnection of the frontal lobe that can be performed in cases of refractory epilepsy due to epileptogenic foci involving 1 frontal lobe (anterior to the motor cortex), with preservation of motor function. In addition to the description of the technique, an illustrative case is also presented. This disconnective procedure is divided into 4 steps: the suprainsular window, the anterior callosotomy, the intrafrontal disconnection, and the frontobasal disconnection. The functional neuroanatomy is analyzed in detail for each step of the surgery. It is important to perform cortical and subcortical electrophysiological mapping to guide this disconnective procedure and identify eloquent cortices and intact neural pathways. The authors describe the case of a 9-year-old boy who presented with refractory epilepsy due to epileptogenic foci localized to the right frontal lobe. MRI confirmed the presence of a focal cortical dysplasia of the right frontal lobe. A periinsular anterior quadrant disconnection (quadrantotomy) was performed. The postoperative period was uneventful, and the patient was in Engel seizure outcome Class I at the 3-year follow-up. A significant cognitive gain was observed during follow-up. Periinsular anterior quadrantotomy may thus represent a safe technique to efficiently treat refractory epilepsy when epileptogenic foci are localized to 1 frontal lobe while preserving residual motor functions.
Sturge-Weber 综合征患者的后象限切除术
DOI：
--
发表时间：
2011
期刊：
影响因子：
--
作者：
Sugano H;Nakanihsi H;Nakajima M;Higo T;Arai H
通讯作者：
Arai H