最常见的手术治疗为 癫痫 involves removing (resecting) the small area of brain tissue where the patient's seizures originate. The goal is to reduce the frequency of seizures or stop them completely.
病灶切除
手术前, 医疗小组进行了广泛的评估,以确定引发癫痫发作的大脑区域. This region may adjoin or overlap areas of the brain used for language, memory, movement and emotion. 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 techniques to avoid or minimize any impact on the surrounding normal brain tissue.
何时考虑手术
手术是为癫痫不能通过癫痫药物很好地控制的人保留的,即所谓的“医学上难治性”或“耐药性”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, 除非患者在几年甚至几十年内尝试过多种药物治疗,否则不会考虑手术. 这些天, surgery may be discussed after just one year of uncontrolled 癫痫, 因为有证据表明,早期的手术是进行的, 结果越好.
- Have seizures that are not satisfactorily controlled by medication
- 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
- Are experiencing intolerable side effects from your seizure medication
评价
病人 being considered for 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, 进入我们的癫痫监测部门(EMU)并进行影像学检查,以确定癫痫发作的位置-称为癫痫发作区-以及该区域是否可以安全移除.
在初次就诊期间, 您将与癫痫专家会面,以回顾您的病史和以前的癫痫治疗,并计划您在加州大学旧金山分校的评估. 我们将与您的初级保健十大赌博平台排行榜和神经科十大赌博平台排行榜沟通,在您的评估过程中讨论您的护理和任何治疗变化.
监测和成像测试
您的癫痫专家可能会建议您入住我们的癫痫监测部门(EMU),这样我们就可以用视频和视频记录您的癫痫发作 脑电图(EEG) 监控. 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. 加州大学旧金山分校的核磁共振成像有一个非常强的磁场——3特斯拉——特别适合评估癫痫. 癫痫中心与放射科密切合作,开发了一种特殊的核磁共振成像方案,提供足够的视觉细节,以识别可能导致癫痫发作的非常细微的大脑异常.
- 宠物. 正电子发射断层扫描(宠物)是一种脑部扫描,用于帮助确定大脑代谢紊乱的存在和位置,这可能有助于我们确定导致癫痫发作的组织. 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, 使用特殊的分析工具将两次扫描之间的统计重要差异映射到患者的核磁共振成像, 最终的扫描结果提供了癫痫发作部位大脑活动的“快照”.
SPECT通常用于频繁发作的患者,当其他影像学检查不能确切地确定发作区域时. - 梅格. Magnetoencephalography (梅格) measures the tiny magnetic fields generated by the brain. 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, the 梅格 measures are distorted less by tissues between the brain and scalp, and are recorded with much greater resolution than is typical with EEG. 结果是, 脑磁图可以比脑电图更精确地定位癫痫相关电干扰的来源. In fact, because of its accuracy, 梅格 is often used when other tests are inconclusive. 此外, 梅格结果可以与核磁共振成像和其他脑成像相结合,提供一个非常全面的脑功能和结构视图.
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, 大多数患者在手术前会与我们的神经心理学家会面,进行一系列的心理练习,以提供有关他们语言的信息, 记忆和理解能力. 这些信息有助于癫痫团队了解癫痫发作的起源以及手术对您的影响. 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.
你也可以与神经心理学家会面,进行Wada测试,以评估你大脑中语言和记忆功能的位置. In a Wada test, one side of your brain is sedated while the other side is being tested. 研究结果确定了大脑的哪一侧是语言和记忆等关键功能的主导区域. 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, 诊断测试给癫痫小组一个关于癫痫发作从哪里开始的想法,但它们不是决定性的. These patients may need further evaluation using intracranial 监控. 颅内监测通过外科手术将电极置于或置于大脑表面来记录脑电波活动, rather than just pasting the electrodes to the scalp as with the initial video-EEG 监控.
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, you will be transferred to the 癫痫 Monitoring Unit for testing. If the intracranial 监控 provides enough information to proceed, 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, 治疗师和手术协调人员将会面,审查评估的各个方面,并为您的具体情况确定最佳治疗方案. 会议结束后, 您的十大赌博平台排行榜或癫痫专科护士将与您联系,讨论所有治疗方案的风险和益处, giving you the opportunity to make an informed decision that best suits your needs and lifestyle.
过程
在切除过程中, the neurosurgeon makes an incision in the scalp and removes a piece of the skull. The surgeon then pulls back the tough membrane covering the brain, called the dura.
外科十大赌博平台排行榜使用术前评估的所有信息,只针对导致癫痫发作的大脑区域,并保护周围健康的脑组织. 在某些情况下, 镇静在手术过程中会减轻, 因此,当病人执行简单的任务,如计数或识别图片时,外科十大赌博平台排行榜可以刺激大脑的不同区域. 这有助于外科十大赌博平台排行榜定位和避开大脑中对语言或运动等重要功能有必要的任何区域. The patient feels no discomfort or distress during this part of the procedure.
一旦癫痫病灶被移除, 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. 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.
Most patients remain in the hospital for three to four days following a surgical resection. 然而, 如果术前需要颅内监测, 你将在计划切除的前一周住院这样我们就可以进行初始手术植入电极. We will then record seizures and complete any 大脑映射 tasks that might be necessary.
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. 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.
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.
你将继续服用与手术前相同的抗惊厥药物至少两年, 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. 它仅用于教育目的,并不打算取代您的十大赌博平台排行榜或其他医疗保健提供者的建议. We encourage you to discuss any questions or concerns you may have with your provider.