Abstracts

RATIONALE: Intractable epilepsy in the area of the functional cortexes, if surgically removed, will cause the lack of neural functions. If using [underline]Multiple Subpial Transection[/underline]() to cure intractable epilepsy will have very good results, but have a chance of causing SAH or a scar, which will cause seizures again. We pilot to study of the resecting the epileptogenic foci combing with [underline]Bipolar Coagulation on Functional Cortexes[/underline] () to evaluate the possibility and effectiveness of using .
METHODS: 124 cases with intractable epilepsy had been surgically treated in Beijing Tiantan Hospital from 1996 to 1999. 75 cases with temple lobe epilepsy underwent anterior temple lobectomy (40 cases), selective amygdalo-hippocampectomy (12 cases) or lesionectomy (23 cases). 48 cases with extra-temple lobe epilepsy underwent lesionectomy (45 cases) or (3 cases). 1 case with infantile hemiplegia with intractable seizures underwent functional hemispherectomy. All patients were examined with intra-operative electrocorticography (EcoG). If the epileptogenic foci were located and involved to the functional cortexes, such as peri-central gyrus, Broca[ssquote]s area and wernicke[ssquote]s area, and can[ssquote]t be resected, combing the was used. The surfaces of multiple cerebral cortexes were coagulated in the bipolar output power 4 U, at intervals 5 mm apart, and duration 1-2 seconds.
RESULTS: There were no SAH and no lack of blood supply to the brain during operated observation. Pathological features indicated that there were coagulation necroses in superficial layers and acute pyknosis and tissue edema adjacent to the superficial layers. The structure of deep cortex was normal. There were 4 cases showed temporary weakness on limb strength and 5 cases aphasia and all be recovered in couple days after surgery. 64 cases were followed up after surgery 1/2-3 years. The seizure free were 80 % (51/64), the seizure attack less than 75% were 12.5%(10/64), the seizure less 50% were 5%(4/64). The general efficiency was 97.5%.
CONCLUSIONS: The best way is that epileptogenic foci can be removed in order cure the epilepsy, but for the epileptogenic foci involved the areas of functional cortexes, combing is useful to control the horizontal synchronization and spread of epileptic discharge. Therefore, the BCFC is easy, safe and available for clinical apply.