Objective To discuss the application of awaking anesthesia and intraoperative cortico-subcortical electrostimulation in the surgery for patients with secondary epilepsy induced by lesions in eloquent areas. Methods A total of 11 patients initiated with epileptic seizure were collected in our study. All patients were right-handed and 5 had neurological dysfunction, and the mean Karnofsky performance status (KPS) scores were 87. Skull MRI and long-term video-EEG monitoring were performed for all patients, and 6 of them got functional MRI. The surgeries were performed under intravenous anesthesia: 4 got trachea intubation and the other 7 were performed pharyngeal esophageal intubation under awaking anesthesia. Electrocorticographic recordings were adopted to confirm the epileptogenic zone, and then cortical electrical stimulus was performed to locate the cortical functional area. Under subcortical electrostimulation monitoring, we resected the lesions by the methods of focal cortical resection or multiple subpial transaction (MST) according to the relation between epileptogenic zone and functional cortex; during the resection, subcortical electrostimulation was adopted to protect the tracts lay in the sub-cortex. Results Total resection was achieved in 10 patients, and subtotal excision in 1. The epileptogenic zone was performed cortical resection or pia mater-fiber transverse amputation.Two cases got transient hemiparalysis after operation. Followed up for 6-20 months, none of the patients had neurologic deficit, and the average KPS scores were 100. Epilepsies were well-controlled using only one antiepileptic drug. Conclusion Pharyngeal esophageal intubation under awaking anesthesia is safe and convenient. With the monitoring of intraoperative cortico-subcortical electrostimulation, we can resect the lesions up to the hilt and protect the eloquent areas effectively, and improve the life quality of patients.

Objective To explore the application of intracranial electrode for epilepsy surgery in refractory epilepsy.Methods 20 patients with refractory epilepsy,whose seizure onset were unable to be located by MRI,Video-sEEG and clinical characteristic,including 12 male and 8 female.All patients were performed long-term video-iEEG using subdural and/or depth electrodes.Cortex strip electrodes were used in 16 patients,both cortex strip electrodes and depth electrodes in 2 patients,and both cortex strip electrodes and grille electrodes in 2 patients.The placement and number of electrodes were determined according to the clinical characteristic and non-invasion examinations.7 of the patients were performed chronic subdural electrostimulation 4～12 days after operation to identify the eloquent area and/or induce clinical seizures.Results The EEG monitoring lasted from 2 to 21 days,average 8.6 days.17 patients could be located for ablative surgery,1 case was did corpus callosotomy,and 2 patients were stopped the monitoring without operation.There were no infection in all patients.There were 17 patients to be followed up above 6 months and collected complete data.The clinical outcome showed that patients were seizure free in 15 cases(88.2%),and improved significantly in 2 cases.Conclusion Which intracranial electrodes to localize epileptogenic zones and function areas in selected patients is a safe and effective method,and they can increase the effect of operation and reduce the neurologic disability.

Objective To retrospectively analyze the surgical treatment of 138 epileptic cases.Methods 138 epileptics, treated withsurgical treatment. Among the total, 119 (86. 2%) were performed resection operation, 11 (8. 0%) corpus callosotomy, 8 (5.8%) resection surgery combined with palliative operation. All operation was performed under electroencephalograqhic monitoring, and electrostimulation were performed for 35 cases to locate the eloquent brain area during surgery. Results Follow up time was 3 to 66 months. 3 cases died of tumor recurrence, 10 failed in follow up, 125 cases were brought into evaluation, among which, 114 cases had been followed up for over 6 months. Surgical effect were evaluated with evaluation system of TAN Qi - fu surgical effect classification, satisfactory in 89 cases (78. 1%),significantly improved in 10 cases (8. 8%), moderate improvement in 11 cases (9. 7%), mild improvement in 2 cases (1.7%), unchanged in 2 cases (1.7%). Conclusion Surgery is an effective treatment for epilepsy, and the key process of improving surgical effect include suitable indication, precise location of epileptogenic zone, level of surgical technique.

目的探讨应用智力、适应行为测试结果对难治性癫痫患者进行健康指导。方法对11例难治性癫痫患者进行中国修订韦氏智力量表及社会适应能力测试,其中8例3~12岁患者进行儿童适应行为评定量表,3例≥16岁患者进行成人智残评定。结果11例患者中,FIQ处于边界水平1例,轻度智力缺损4例,中度智力缺损2例,重度智力缺损1例。ADQ处于正常2例,轻度缺损4例、中度缺损3例、重度缺损2例。结论根据测试结果,对难治性癫痫患者进行早期认知功能的康复和教育,从而提高其生活质量。

Objective:To evaluate the intelligence and adaptive behavior of patients with refractory epilepsy.Methods:Using Chinese modification of Wechsler intelligence scale and adaptive behavior scale to analyze 11 patients of refractory epilepsy.8 cases aged 3~12 years were evaluated by Children Adaptive Behavior Scale and 3 cases older than 16 years age were evaluated by Adult Mental Handicap Scale.Results:Eight cases' intelligence including verbal intelligence quotient(VIQ),performance intelligence quotient(PIQ) and full intelligence quotient(FIQ) were lower than normal.One's FIQ situated at the boundary level.Other 7 cases showed deficient intelligence,including 4 mild,2 medium and 1 severe.Three patients couldn't finish the test because of anepia.Their adaptive behavior present normal in 2 cases,light discrepancy in 4,medium impairment in 3 and severe defect in 2.Conclusions:The major patients with refractory epilepsy display some visible intellective defects and disorders of adaptive behavior.

Objective:To invetigate the value of a novel puncture and drainage of intracranial hematoma for the treatment of hypertensive intracerebral hemorrhage.Methods:In the group there were 27 patients with hypertensive intracerebral hemorrhage,with mean age of 61 years. Their hematomas located in thalamus(1 patient),basal ganglia(22 patients),and lobe(4 patients).The mean(SD)hematoma volume was 40(3.2)mL,the mean Glasgow Coma Scale (GCS)score was 10.15,and the mean National Institutes of Health Stroke Scale(NIHSS)score was 30.65 at admission.CT scan provided hematoma location.and the percutaneous puncture. grind and drainage were performed under the local anesthesia by using a novel puncture and drainage of intracranial hematoma.Results:No adverse events occurred during the punctures and after the procedures.One patiems died 20 days after procedure.Other patients were followed up for more than 6 months.Eight patients had a good outcome as assessed by Glasgow Outcome Scale(GOS)scores,15 had mild disability,2 had serious disability,and 1 was in a permanent vegetative state.Conclusions:This novel puncture and drainage of intracranial hematoma can be used in the treatment of hypertensive intracerebral hemorrhage,and it is simple and safe.

Objective To summarize the experience in diagnosing and surgically treating symptomatic epilepsy. Methods MRI and long-term video-electroencephalogram (EEG) examinations were performed before the surgery in 19 patients with symptomatic epilepsy in order to locate the intracranial lesions and epileptogenic zone. One patient received intracranial EEG examination besides MRI and video-EEG. The operations are performed under monitoring by electrocorticogram in 19 patients, of whom, 15 underwent resection of the lesions and epileptogenic cortexes, 2 the resection of lesions and multiple subpial transections, and 2 the resection of lesions and anterior temporal lobectomy. Results No serious complication occurred in all the patients. The histopathological examination showed that of 19 patients, 2 suffered from dysembryoplastic neuroepithelial tumors, 4 from astrocytic tumors of grade Ⅰ-Ⅱ, 2 from oligodendrogliomas, 3 from anaplastic astrocytomas, 3 from cerebral arteriovenous malformations, 3 from cavernous hemangiomas, 1 from arachnocyst, and 1 from arachnocyst accompanied with focal cortical dysplasia. According to Engel classification of curative effect on epilepsy, of 14 patients who were followed up 6 months after the operation, 13 belonged in gradeⅠ and 1 in grade Ⅱ. Conclusions The patients with epilepsy should be actively examined in order to find the cause of epilepsy. The satisfactory results will be achieved by surgical treatment in the patients with symptomatic epilepsy.

Objective To discuss the experiences in successful treatment of hyperacute traumatic intracranial hematoma with percutaneous puncture and craniotomy.Methods Pereutaneous puncture and craniotomy was performed in 12 patients with hyperacute traumatic intracranial hematomas including seven with subdural hematoma,three with epidural hematoma and two with episubdural hematoma.Before operation,there found enlargement of bilateral pupil in six patients,enlargement of unilateral pupil in six and changed breathing rhythmicity in eight.Glasgow Coma Scale(GCS)was 3 points in four patients,4 points in six and 7 points in two.Results After pereutaneous puncture,enlarged pupil was retracted at different degrees in nine patients and spontaneous breathing conditions improved in seven.After crani otomy,two patients died within 24 hours,four died after 24 hours but six patients survived.The follow-up for 0.5-2 years showed four patients with sound Glasgow Outcome Score,two at vegetative state and six deaths.Conclusion Percutaneous puncture combined with craniotomy is an effective way for hyperacute intracranial hematoma.

目的 探讨经皮穿刺在救治特急性颅内血肿中的作用.方法 对13例特急性颅内血肿的患者在开颅术前先进行紧急经皮穿刺.硬脑膜下血肿7例,硬脑膜外血肿3例,硬脑膜外合并硬脑膜下血肿2例,自发性脑内血肿1例;术前双侧瞳孔散大7例,单侧瞳孔散大6例;呼吸改变者9例;入院GCS 3分4例,4分6例,5分1例,7分2例.结果 穿刺后10例患者瞳孔有不同程度回缩,8例患者自主呼吸转平稳.手术治疗11例,余2例未能手术.术后随访6个月至2年,按GOS评分,良好4例,重残1例,植物生存2例,死亡6例.结论 在特急性颅内血肿的救治中,先期的紧急经皮穿刺,能为后期的治疗提供有效帮助.