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[Objective]: This paper examines whether patients with refractory epilepsy cranial MRI normal performance value; surgical treatment and postoperative effects of surgical treatment; guidance and pathological changes after surgical strategy; to raise these patients surgery The efficacy of the treatment. [Method]: retrospective study of January 2008 6 December 3 - 2009 III the hospital neurosurgery admitted the 73 cases of surgical treatment of refractory epilepsy patients medical records; collect a history of clinical seizures characteristics, preoperative skull MRI imaging data of the monitoring results of the 24-hour long-distance video-EEG (24-VEEG) the cortical electrodes buried in the preoperative clinical data, intraoperative cortical electrode monitoring and surgical techniques, postoperative pathologic results. All surgical patients in the hospital 1.5T MRI downlink brain imaging scans, in accordance with the results of its scan more patients were divided into two groups: the first group, all patients with cranial MRI imaging abnormalities, which is defined as cranial MRI normal performance in patients with refractory epilepsy (patient 40, including 29 men, 11 women, aged 8-42 years old, with an average age of 20.5 years, seizures duration of 6 months -23 years, with an average duration of 9.4 years; MRI scan of the patient's skull); second group are abnormal performance (patient 33, including 29 men, four women, aged 9-60 years old, with an average age of 22.5 years old, epilepsy duration of 10 days -24 years, with an average duration of 7.9 years), imaging diagnosis include: malacia, arachnoid cyst, meningioma, brain atrophy, hippocampal sclerosis, vascular malformations, schizencephaly absence of glioma and septum pellucidum. All patients underwent 24-hour video electroencephalogram (24h-VEEG) monitoring, recording under attack (ictal EEG) and interictal (interictal EEG) abnormal EEG, parallel epileptogenic focus given side and locate. Abnormal EEG interictal and ictal limitations and directly caused by the location of the epileptic foci in patients with clear surgical treatment, intraoperative use of the 20 guide palisade cortex electrodes to monitor the location of epileptogenic focus again to clear the extent of surgical resection. For preoperative use of non-invasive EEG (non-invasive EEG) lateralization and location of epileptic foci of patients can not be clearly caused by the need to line the the bilateral subdural cortex electrodes buried surgery to do and position of the side to the epileptic foci, re epileptic focus resection. All surgical resection specimens underwent common pathological examination (H-E staining), the pathological changes of the brain tissue samples to clear resection. All patients discharged review routine EEG after discharge from outpatient review, telephone counseling, writing letters, etc., follow-up, control efficacy of postoperative follow-up period of at least one year or more, according to internationally accepted Engel classification evaluation of its epilepsy . [Results]: 40 cranial MRI normal performance of refractory epilepsy patients, mean postoperative follow-up of 1.8 years, of which 16 (40%) patients with epilepsy full control Engel Ⅰ level 19 (47.5%) rarely seen in patients with epilepsy attack, average episodes 1 to 2 times a year or only a night attack, reaching Engel Ⅱ level; 3 (7.5%) patients with seizures decreased by 90%, compared with the preoperative Engel Ⅲ; 2 (5 %) in patients with postoperative seizure control did not improve, level Engel Ⅳ. The second group of 33 cranial MRI abnormalities in patients with refractory epilepsy, mean postoperative follow-up of 1.8 years, 18 (54.5%) patients with epilepsy completely control reached Engel Ⅰ; 7 (21%) patients epilepsy rare attack, the average episodes 1 to 2 times a year or only a night attack, reached Engel Ⅱ-level; 4 (12%) patients with seizures decreased by 90% compared with the preoperative reached Engel Ⅲ level; 4 patients (12%) postoperative seizure control did not improve, level Engel Ⅳ. The above two groups of patients with epilepsy control efficacy was no statistically significant difference (P gt; 0.05). Common postoperative pathologic examination: the first group of 40 normal cranial MRI performance refractory epilepsy patients in 29 cases of frontotemporal resection, the hippocampus and other brain tissue specimens can be found malacia, vacuolar degeneration of brain cells The part of the brain cell edema, spotting, thin-walled blood vessels to dilate, gliosis, and other non-specific changes; while the remaining 11 cases of brain tissue in addition to a little bit like spotty bleeding, not found in other pathological abnormalities. The second group of 33 cranial MRI abnormalities in patients with refractory epilepsy pathologic changes include: diffuse astrocytoma, gravel meningioma, hippocampal sclerosis, arachnoid cyst, vascular malformations, as well as non-specific pathological changes (including focal softening of local brain tissue, vacuoles and cloudy swelling degeneration of brain cells, spotting, reactive inflammation, glial mild hyperplasia). [Conclusion: This study showed 87.5% of patients with intractable epilepsy patients with normal cranial MRI performance good seizure control (up to Engel Ⅰ the Engel Ⅱ grade), compared with a combination therapy for a variety of anti-epileptic drugs (antiepileptic drugs, AEDS) better efficacy; and pathologically confirmed normal performance of 70% (28/40) cranial MRI in patients with refractory epilepsy resection of brain tissue pathological changes, so these patients after strict preoperative assessment clearly caused the location of the epileptic foci, early surgical treatment.
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