断开手术是一种外科治疗 癫痫. 不像 切除术 — where surgeons remove the brain tissue responsible for the patient's seizures — disconnection procedures may not involve the removal of any tissue. 而不是, surgeons attempt to stop or reduce seizures by cutting the nerve pathways through which seizure impulses travel in the brain.
断开程序
断开连接程序可能是一个选择,如果你有严重的, 不受控制的癫痫发作起源于大脑的多个区域, or if the tissue where your seizures originate cannot be safely removed.
There are three main types of disconnection procedures: functional hemispherectomy, 胼胝体切开术和多次枕下横断.
功能性大脑半球切除术
在功能性半球切除术中, 外科十大赌博平台排行榜从大脑一侧切除组织, 叫做半球, 病人的癫痫是从哪里发作的. They also cut the connections between the two hemispheres so seizures can't spread from one side of the brain to the other.
Hemispherectomy is reserved for patients (usually children) who have severe, uncontrolled 癫痫 with seizures arising from only one side of the brain. It is performed only if that hemisphere is already functioning very poorly, so the patient loses little to no additional function after the surgery.
在功能性半球切除术后, more than 80 percent of patients experience complete or nearly complete seizure control. 然而, the procedure is less effective for patients with progressive disorders such as Rasmussen's syndrome.
、胼胝体
该手术包括切除胼胝体, 神经束连接两个大脑半球的神经纤维束. 这可以防止癫痫从一个半球扩散到另一个半球. 癫痫仍然会发生,但可能会变得不那么严重.
通常,只剪掉前面三分之二的头发. 这被称为“部分胼胝体切开术”.“如果这不能充分控制病人的癫痫发作, the remaining one-third may be cut in a second procedure (a "complete callosotomy").
胼胝体切开术保留给严重的, 无法控制的癫痫会影响大脑的两个半球. It is most effective in people who suffer from generalized atonic or tonic seizures (also called "drop attacks"), 以及强直阵挛性癫痫.
平均, patients see the frequency of their seizures reduced by 70 to 80 percent after a partial callosotomy and 80 to 90 percent after a complete callosotomy.
多次枕下横切
多次枕下横切 may be an option for patients with partial seizures that arise in an area of the brain that cannot be safely removed. 在程序中, 外科十大赌博平台排行榜做了一系列浅切口, 称为横断, in the area of the cerebral cortex 病人的癫痫是从哪里发作的. These cuts are thought to interrupt the fibers that connect to neighboring parts of the brain — stopping the spread of the seizure impulses — without causing long-lasting impairment of important functions. 然而, transections in areas of the brain responsible for language may cause mild language impairments.
This procedure has been especially successful for people who have an unusual type of 癫痫 called Landau-Kleffner Syndrome.
评价
病人 being considered for any type of 癫痫 surgery will undergo an extensive pre-surgical evaluation. 在加州大学旧金山分校,这包括参观 诊所, admission to our 癫痫 Monitoring Unit (EMU) and imaging tests to help determine where your seizures might arise in the brain.
在初次就诊期间, you will meet with an 癫痫 specialist to review your medical history and previous 癫痫 care and to plan your evaluation at UCSF. We will communicate with your primary care doctors and neurologist to discuss your care and any treatment changes throughout your evaluation.
监测和成像测试
Your 癫痫 specialist may recommend that you be admitted to our 癫痫 Monitoring Unit (EMU) so we can record your seizures using video and electroencephalogram (EEG) monitoring. 病人一般会在EMU呆3到5天. This allows us to determine your particular type of 癫痫 and where your seizures may arise, 如果它们起源于大脑的单一区域.
此外,您还可以接受以下一项或多项测试:
- 核磁共振成像. This non-invasive scan uses a magnet to form detailed pictures of your brain. UCSF's 核磁共振成像 has a very strong magnetic field — 3 Tesla — that is especially well suited to evaluating 癫痫. The 癫痫中心 has worked closely with the radiology department to develop a special 核磁共振成像 protocol that provides enough visual detail to identify even very subtle brain abnormalities that may cause seizures.
- 宠物. Positron emission tomography (宠物) is a brain scan used to help determine the presence and location of brain metabolic disturbances that may help us pinpoint the tissue responsible for seizures. The findings from 宠物 help support or interpret findings from video-EEG or 核磁共振成像. 宠物 can be particularly helpful when no definite abnormalities appear on 核磁共振成像. 在加州大学旧金山分校,宠物技术与核磁共振成像相结合,以提高准确性.
- SPECT. Single photon emissions computerized tomography (SPECT) is a brain scan that reflects blood flow. For the scan, a small amount of radioactive compound is injected intravenously as a seizure begins. 这种无害的化合物起着示踪剂的作用, glowing brightly in areas of increased blood flow related to seizure activity in the brain. 这个扫描, 称为临界SPECT, is compared to a scan obtained when the patient is not having a seizure. 加州大学旧金山分校, special analysis tools are used to map the statistically important differences between the two scans to that of the patient's 核磁共振成像, resulting in a final scan that provides a remarkable "snapshot" of brain activity in the location of the seizures.
SPECT is usually reserved for patients with frequent seizures when other imaging tests have not conclusively pinpointed the seizure onset zone. - 梅格. Magnetoencephalography (梅格) measures the tiny magnetic fields generated by the brain. 这和脑电图非常相似, which records the electrical activity generated by the same neurons using electrodes pasted on the scalp. 与脑电图相比, the 梅格 measures are distorted less by tissues between the brain and scalp, 并且记录的分辨率比典型的脑电图高得多. 结果是, 梅格 can be used to locate the source of 癫痫-related electrical disturbances with greater precision than EEG. In fact, because of its accuracy, 梅格 is often used when other tests are inconclusive. 此外, 梅格 results can be combined with 核磁共振成像 and other brain imaging to provide a very comprehensive view of the brain's function and structure.
梅格只在加州的几所学校提供, UCSF拥有全美首屈一指的梅格实验室之一.S.
神经心理学测试
除了影像学检查, most patients will meet with our neuropsychologist to go through a series of mental exercises that provide information on their language, 记忆和理解能力. This information helps the 癫痫 team understand both where your seizures originate and how surgery may affect you. 测试是非判断性的,在舒适的环境中完成, welcoming environment by a neuropsychologist who specializes in 癫痫.
You may also meet with the neuropsychologist for a Wada test to evaluate where speech and memory functions are located in your brain. In a Wada test, one side of your brain is sedated while the other side is being tested. The results determine which side of the brain is the dominant area for the crucial functions of speech and memory. It will also determine if you will need to be awake during part of the surgery.
颅内监控
在某些情况下, the diagnostic tests give the 癫痫 team an idea as to where the seizures start but they are not conclusive. These patients may need further evaluation using intracranial monitoring. 颅内监控 records brain wave activity using electrodes placed surgically in or on the surface of the brain, rather than just pasting the electrodes to the scalp as with the initial video-EEG monitoring.
加州大学旧金山分校是美国为数不多的医学中心之一.S. 提供立体脑电图(SEEG), 一种侵入性较小的颅内监测形式, 以及标准的硬膜下网格. Your surgical team will discuss SEEG with you if you are a potential candidate.
After the electrodes have been placed in the operating room and your condition is stable, 你将被转到癫痫监测组接受检查. 如果颅内监测提供了足够的信息进行手术, 断开手术定于下周进行.
癫痫外科会议
在决定治疗建议之前, 一组加州大学旧金山分校的癫痫学家, 神经外科十大赌博平台排行榜, 神经心理学家, 高级实习护士, therapists and surgery coordination staff will meet to go over all aspects of your evaluation and determine the best treatment options for your particular case. 会议结束后, your doctor or 癫痫 nurse specialist will contact you to discuss the risks and benefits of all treatment options, giving you the opportunity to make an informed decision that best suits your needs and lifestyle.
过程
Before the procedure, the patient will be put to sleep using general anesthesia. The neurosurgeon will make an incision in the scalp and remove a piece of the skull. 然后外科十大赌博平台排行榜将覆盖大脑的坚硬膜拉开, 叫做硬脑膜, 暴露大脑.
断开后的程序, the surgeon will replace the dura and bone and close the scalp using stitches or staples. 手术当晚是在重症监护室度过的. By the next day, patients should be able to eat and get up and walk with assistance. Pain is managed with intravenous medications until it is mild enough to be controlled with oral medications.
Most patients remain in the hospital for three to four days following a disconnection procedure.
复苏
手术后, you can expect swelling and bruising on the scalp around the incision and, 在某些情况下, 在脸上. 这通常会在手术后4到6周内消失.
You will have your stitches or staples removed 10 to 14 days after surgery, 要么在加州大学旧金山分校要么在你当地的十大赌博平台排行榜办公室.
Most patients experience headaches during the first few weeks after surgery. 头痛会逐渐变得不那么频繁和剧烈. Other effects of the surgery may include decreased ability to concentrate, 健忘和找词困难. In most cases, these problems gradually improve over the first few weeks.
手术后病人很容易疲劳是很常见的, 尤其是出院后的头几天. Most people feel back to normal and resume their usual activities about four to six weeks after surgery.
Most patients are put on steroids after surgery to minimize brain swelling. 手术后两到三周会逐渐减少. 这会导致暂时的戒断症状, including increased headache; slight stiffness in the neck, lower back or leg; low fever; irritability; and mild swelling under the incision.
You will continue to take the same anticonvulsant medications you took before surgery for at least two years, 即使你没有癫痫发作, 除非你的十大赌博平台排行榜另有指示.
你会得到详细的术后指导, as well as directions on how to contact the neurosurgery team with any questions or concerns, 在你出院之前.
For more information, please contact one of our 癫痫 nurse specialists:
神经学:
Maritza Lopez, (415)719-7888
神经外科:
玛丽安·沃德,(415)353 -2347
加州大学旧金山分校健康医学专家已经审查了这些信息. It is for educational purposes only and is not intended to replace the advice of your doctor or other health care provider. We encourage you to discuss any questions or concerns you may have with your provider.