最常见的手术治疗为 癫痫 包括移除(切除)患者癫痫发作的小区域脑组织. 目标是减少癫痫发作的频率或完全停止它们.
病灶切除
手术前, the medical team conducts an extensive evaluation to pinpoint the region of the brain that is triggering seizures. 这个区域可能与大脑中负责语言、记忆、运动和情感的区域相邻或重叠. 为了保护这些功能,加州大学旧金山分校的神经外科十大赌博平台排行榜使用先进的 大脑映射 避免或尽量减少对周围正常脑组织的影响的技术.
何时考虑手术
Surgery is reserved for people whose 癫痫 is not well controlled by seizure medications — what's called "medically refractory" or "drug-resistant" 癫痫. 考虑做手术, 病人至少服用过两种抗癫痫药物, 剂量足够时, 没有达到令人满意的控制致残癫痫发作.
在过去, surgery wasn't considered unless the patient had tried multiple medications over several years or even decades. 这些天, 在癫痫不受控制一年后,可以讨论手术, 因为有证据表明,早期的手术是进行的, 结果越好.
- 癫痫发作不能通过药物得到满意的控制
- 有掉落(原子)攻击
- 有部分发病(局灶性)癫痫发作吗
- 是否有脑部结构性问题——比如良性的 脑部肿瘤, 中风 或者血管畸形——引起癫痫发作
- 你的癫痫药物有无法忍受的副作用吗
评价
考虑手术的患者将接受广泛的术前评估. 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 determine where your seizures arise — called the seizure onset zone — and if this region can be safely removed.
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 脑电图(EEG) 监控. 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, which records the electrical activity generated by the same neurons using electrodes pasted on the scalp. 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 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 before surgery 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, 切除手术安排在下周.
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
在切除过程中, 神经外科十大赌博平台排行榜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拉回覆盖大脑的坚硬膜,称为硬脑膜.
The surgeon uses all the information from the pre-surgical evaluation to target only the area of the brain responsible for the seizures and to protect surrounding healthy brain tissue. 在某些情况下, 镇静在手术过程中会减轻, so the surgeon can stimulate various areas of the brain while the patient performs simple tasks such as counting or identifying pictures. This helps the surgeon locate and avoid any areas of the brain that are necessary for important functions such as language or movement. 在这一过程中,患者不会感到不适或痛苦.
一旦癫痫病灶被移除, 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. Pain is managed with intravenous medications until it is mild enough to be controlled with oral medications.
大多数患者在手术切除后要住院三到四天. 然而, 如果术前需要颅内监测, you will be hospitalized the week prior to the planned resection so we can perform an initial surgery to implant the electrodes. 然后我们将记录癫痫发作并完成任何必要的脑部绘图任务.
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. Most people feel back to normal and resume their usual activities about four to six weeks after surgery.
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.