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.
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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, 或者你癫痫发作的组织不能安全移除.
有三种主要类型的断开手术:功能性半球切除术, 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.
半脑切除术保留给患有严重脑病的患者(通常是儿童), 不受控制的癫痫症,只在大脑的一侧发作. 只有在这个半球功能已经很差的情况下才会进行, 所以病人在手术后几乎没有失去额外的功能.
在功能性半球切除术后, 超过80%的患者经历了完全或几乎完全的癫痫控制. 然而, 对于像拉斯穆森综合征这样的进行性疾病患者,这种手术效果较差.
、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, 剩下的三分之一可以在第二次手术中切除(“完全胼胝体切开术”)。.
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, 在病人癫痫发作的大脑皮层区域. 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, 大脑中负责语言的区域的横断可能会导致轻微的语言障碍.
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. 这使我们能够确定您的特定类型的癫痫和癫痫发作可能出现的地方, 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. 这种非侵入性扫描使用磁铁形成大脑的详细图像. 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. 宠物的结果有助于支持或解释视频脑电图或核磁共振成像的结果. 当核磁共振成像没有明确异常时,宠物尤其有用. 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. 单光子发射计算机断层扫描(SPECT)是一种反映血流的脑部扫描. 在扫描中,当癫痫发作时,通过静脉注射少量放射性化合物. 这种无害的化合物起着示踪剂的作用, 在大脑中与癫痫活动相关的血流增加的区域发出明亮的光. 这个扫描, 称为临界SPECT, 与患者没有癫痫发作时的扫描结果进行比较. 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. 脑磁图(梅格)测量大脑产生的微小磁场. 这和脑电图非常相似, 用贴在头皮上的电极记录同一神经元产生的电活动. 与脑电图相比, 脑磁图测量结果受大脑和头皮之间组织的影响较小, 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. 事实上,由于梅格的准确性,当其他测试没有定论时,梅格经常被使用. 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, 由专门研究癫痫的神经心理学家提供的温馨环境.
You may also meet with the neuropsychologist for a Wada test to evaluate where speech and memory functions are located in your brain. 在十大赌博平台排行榜反兴奋剂机构的测试中,你的一侧大脑被注射了镇静剂,而另一侧正在接受测试. The results determine which side of the brain is the dominant area for the crucial functions of speech and memory. 它还将决定你是否需要在部分手术过程中保持清醒.
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. 这些患者可能需要通过颅内监测进一步评估. 颅内监控 records brain wave activity using electrodes placed surgically in or on the surface of the brain, 而不是像最初的视频脑电图监测那样,把电极贴在头皮上.
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. 如果您是潜在的候选人,您的手术团队将与您讨论SEEG.
在电极被放入手术室并且你的情况稳定之后, 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, 让你有机会做出最适合自己需求和生活方式的明智决定.
过程
在手术前,病人会被全身麻醉进入睡眠状态. 神经外科十大赌博平台排行榜会在头皮上开一个切口,取出一块颅骨. 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, 外科十大赌博平台排行榜将更换硬脑膜和骨头,并用针或订书钉缝合头皮. 手术当晚是在重症监护室度过的. 到第二天,患者应该能够在帮助下吃饭、起床和行走. 疼痛是通过静脉注射药物来控制的,直到疼痛轻微到可以通过口服药物来控制为止.
在断开连接程序后,大多数患者在十大赌博平台排行榜停留三到四天.
复苏
手术后, 切口周围头皮会有肿胀和淤青, 在某些情况下, 在脸上. 这通常会在手术后4到6周内消失.
手术后10到14天,你需要拆除缝线或订书钉, 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.
大多数患者在手术后的最初几周会感到头痛. 头痛会逐渐变得不那么频繁和剧烈. 手术的其他影响可能包括注意力下降, 健忘和找词困难. 在大多数情况下,这些问题在最初几周内逐渐改善.
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. 大多数人在手术后4到6周会感觉恢复正常并恢复日常活动.
大多数病人在手术后服用类固醇以减少脑肿胀. 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, 以及如何与神经外科团队联系的指导,如果有任何问题或疑虑, 在你出院之前.
欲了解更多信息,请十大赌博平台排行榜的癫痫专科护士:
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. 我们鼓励您与您的供应商讨论您可能遇到的任何问题或疑虑.