Treatment For Refractory Epilepsy Originated From Language Areas And Around With Neurosurgical Operation

Objective To explore the method of pre-operative evaluation process and micro-neurosurgical treatment in the patients with refractory epilepsy originated from language areas and around.Methods 16 cases originated in the language area and its vicinity refractory epilepsy patients before routine use of long-term video-EEG (VEEG), CT, magnetic resonance imaging (MRI), functional magnetic resonance imaging (fMRI), Wechsler adult intelligence Scale-Revised in China(WAIS-RC) and other tests in preoperative evaluation: long-term video-EEG (VEEG) with full monitoring of the ward, 24-hour dynamic tracking, recording the whole process of their seizures to determine the location and frequency of seizures, volatility, etc.; CT and the preoperative MRI lesions in the initial positioning of the qualitative, fMRI is a Chinese word by identifying the language of the task stimulus, in order to achieve the brain areas activated language function, clear-induced epileptic foci and the location of the relationship between language function areas. And used in China and the revised Wechsler Adult Intelligence Scale Vocabulary fluency tests for each language function in patients with preoperative evaluation. The sections discussed and decided a good surgical treatment. Surgical techniques: intraoperative use of fMRI-assisted neuronavigation with cortical electroencephalography (ECoG), in the protection of language function areas addressed on the basis of microsurgical resection of epileptic foci. Follow-up: After January-line video-EEG review, 3 months after row of video-electroencephalogram, Wechsler Adult Intelligence Scale language features such as follow-up re-assessment of the situation. Statistical methods: Preoperative and postoperative mental situation and the vocabulary fluency test data using statistical software for statistical comparative analysis to understand whether the statistical difference.Results Found that lesions in the Broca area (left posterior inferior frontal gyrus: Eloquent cortex) in the vicinity of 7 cases, in the Wernicke area (left temporal lobe and the top leaf margin on the upper back: auditory language center) near the 5 cases, in both the between the four cases. Pathological Tip: 7 cases of focal cerebral cortex dysplasia; three cases of cavernous hemangioma; three cases of heterotopic gray matter disease; two cases of calcification; 1 case oligodendrocytes astrocytoma. 16 cases with 14 cases of postoperative recovery was good, there are two cases occurred 1 day after the first seizure situation, and accompanied by a brief movement of language dysfunction (dysfunction of motor aphasia: Speech vague), 1 week completely back to normal. Post-discharge follow-up after 2 weeks, 1 month, 3 months, 6 months, 14 patients with no seizures, and 1 case was 1 month after onset of a second, and 1 case was after 1 month and 3 months, When the attack a second. 16 patients were discharged from hospital within two weeks after the operation. After no obvious dysfunction. All surgical patients were on after 1 month, 3 months, hospital follow-up review of video-electroencephalogram (EEG): 13 were normal, 3 cases of mild abnormalities prompted EEG. 3 months after to use China's revised Wechsler Adult Intelligence Scale and the vocabulary fluency test to patients with mental re-assessment of the situation languages, data and preoperative data, statistical analysis, results indicate no significant statistical difference.Conclusion functional magnetic resonance imaging, neuronavigation and cortical electrode scans a joint application is surgery originated in the language area and its nearby areas with refractory epilepsy effective method. Detailed assessment of preoperative, intraoperative fMRI neuronavigation with ECoG microsurgical resection of epileptic foci, which can effectively avoid the functional area, in the treatment of epilepsy at the same time be able to maximize the protection of language function; function and preoperative and postoperative verbal fluency Comparative evaluation of tests for evaluating surgical treatment of great significance, their evaluation of surgical success or failure can be used as an important indicator.