especially for refractory epilepsy has shown better results. However, at present, not only are patients still puzzled and afraid of surgery, but also many medical personnel lack an understanding of the surgical treatment of epilepsy, including the indications, surgical procedures, and therapeutic efficacy. Epilepsy, commonly known as "crohn's disease" or "epilepsy", is a kind of temporary brain function abnormality disease with recurrent seizures, which is one of the recognized problems in the medical field. In the past, it was mainly treated by medication, but there is no curative drug yet, and many patients need long-term or even lifelong medication to control it. Surgical treatment has brought the gospel to epilepsy patients. According to statistics, at present China's epilepsy patients amounted to 5 million-7 million people, of which 2 million-3 million patients can receive surgical treatment.
The following epilepsy adapted to surgical treatment. Of course, with the continuous improvement of medical equipment and technology, the scope of indications is still expanding.
1, long-term systematic treatment with antiepileptic drugs is ineffective, and even have a tendency to worsen;
2, epilepsy course is more than 4 years, frequent seizures, at least 4 seizures per month;
3, epilepsy makes the patient unable to live, work or study normally;
4, epilepsy-causing foci are not in the important functional areas of the brain, and the drug treatment is ineffective, and the surgery does not Bring obvious disability to the patient;
5, CT, nuclear magnetic **** vibration and other examinations found that there are typical epileptogenic foci in the brain, the foci can be surgically resected.
What are the surgical methods
On the basis of strict mastery of surgical indications, different types and methods of surgery should be selected according to the different conditions of each patient, and the commonly used surgical methods are as follows:
Local resection of foci, which is the most commonly used at present and has the most satisfactory effect, is adapted to the brain with obvious tumor occupancy, cerebral abscess, and inflammatory lesions, It is suitable for epilepsy caused by obvious tumor in the brain, brain abscess, inflammatory foci, vascular malformation, cerebral softening, hematoma mechanization, etc. About 60%-90% of this kind of epilepsy can be cured by surgical resection at one time. The anterior temporal lobe resection and selective amygdala-hippocampectomy also belong to the category of localized resection.
Hemispherectomy is suitable for intractable grand mal seizures, epileptic source area involving most or all of one hemisphere, such as infantile spastic hemiplegia, hemizygous megalencephaly and other intractable epilepsies, and the effective rate of epilepsy control can reach more than 80% if the indications for surgery are correctly selected.
Corpus callosum anterior 2/3 dissection, the corpus callosum is the neural tissue connecting the right and left cerebral hemispheres, it is the joint fiber of epileptic discharge conduction to the opposite side, and the purpose of cutting it off is to restrict the epileptic discharge to the abnormal side and not to make the epilepsy spread. This procedure is more suitable for refractory, generalized and persistent seizures with extensive foci located in the frontal lobe of the brain, as examined by electroencephalogram (EEG).
Stereotactic surgery, the advantage of this surgery is that it does not require craniotomy and has little damage to the brain tissue, but it requires high precision in localization. The purpose of the surgery is to destroy the epileptogenic nuclei through stereotactic, blocking the spread of epileptic discharges, temporal lobe epilepsy is particularly suitable for this surgery.
Subcortical cutoff, a surgical method to cut off the transverse fibers of the neural origin under the soft meninges in multiple places, in order to block the spread of synchronous neuronal discharges in epileptic foci. It is mainly applicable to refractory epilepsy in the major functional areas of the brain.
Chronic cerebellar stimulation, the procedure involves placing special deep brain stimulation electrodes in the anterior or posterior lobes of the bilateral cerebellar cortex, which stimulate the cerebellum through the radio receivers connected to each other buried in the subcutaneous area, thus reducing the number of epileptic seizures. This method is more suitable for generalized or bilateral temporal lobe with foci of epilepsy, clinical efficacy of 70%.
The triple combination of bright light stimulation, surgery and medication, the neurosurgery department of the Armed Police General Hospital, on the basis of surgical treatment of intractable epilepsy, after 6 years of research, used 10,000 lux bright light irradiation plus brain surgery and medication to treat more than 40 cases of intractable epilepsy that had been ineffective in the past with various methods of treatment, and achieved a unique effect. For example, a case of 16-year-old boy suffering from intractable epilepsy, grand mal and petit mal seizures more than 10 times a day, head and face often fall, the whole body is bruised, more than 30 hospitals across the country are ineffective in the treatment, the use of this therapy for a one-time cure.
What is the difference between epilepsy knife surgery and traditional surgery
Traditional epilepsy surgery generally adopts EEG with CT, MR*** vibration and other imaging equipment for localization at the lobe level, and relies on this method of surgical treatment, with an effective rate of only about 50 percent. "Epilepsy Knife" is mainly composed of dipole three-dimensional intracranial epileptic foci localization system, spike automatic analysis system and 64-guide digital video EEG synchronous long-range monitoring system. The significant difference between "Epilepsy Knife" and traditional epilepsy surgical treatment is that it adopts digital technology and synchronized video monitoring technology, i.e., digital guidance to realize the localization and diagnosis of "foci", which has high accuracy and strong anti-interference ability; and it can provide the basis for accurate analysis of the condition and in-depth analysis of the bioelectrical activity of brain tissue cells. It can provide precise parameters for accurate analysis of the condition and in-depth analysis of the bioelectrical activity of brain tissue cells, thus enabling the localization and diagnosis of epileptogenic foci of intractable epilepsy to reach the millimeter level, and providing precise guidance for surgery. If the surgery adopts "minimally invasive epileptogenic foci destruction surgery", and comprehensively utilizes laser, radiofrequency, microscopic technology and other advanced means, the effective rate of epilepsy surgical treatment can reach more than 95%. The first set of "Epilepsy Knife" introduced by Pearl River Hospital in Asia has been used in clinical practice. Until August 1999, the Department of Neurosurgery of the hospital had successfully treated 23 epileptic patients with "Epilepsy Knife". According to the postoperative follow-up survey, all the epileptic symptoms of the patients disappeared, and none of them had another seizure. In Xiamen, a middle-aged man who had suffered from epilepsy for more than 10 years and whose condition had worsened for half a year, with frequent convulsions of the limbs and confusion, was treated with the Epilepsy Knife and discharged from the hospital with satisfactory results. In conclusion, with the increasing maturity of surgical treatment of epilepsy technology, it will become the main means of treatment of refractory epilepsy. However, due to the complexity of the cause, pathology and clinical type of epilepsy, for each different patient with epilepsy, the decision of whether to operate or not should be made by a specialist according to different examination results and the appropriate surgical method should be selected