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. 他们还切断了两个大脑半球之间的连接,这样癫痫就不会从大脑的一侧扩散到另一侧.
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. 它对患有全身性失张力或强直性癫痫发作(也称为“跌落发作”)的人最有效。, 以及强直阵挛性癫痫.
平均, 在部分胼胝体切开术后,患者癫痫发作的频率减少了70%到80%,而在完全胼胝体切开术后,癫痫发作的频率减少了80%到90%.
多次枕下横切
多次基底下横断可能是一种选择,患者部分癫痫发作出现在大脑的一个区域,不能安全切除. 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. 这些切口被认为会中断连接到大脑邻近部分的纤维,从而阻止癫痫冲动的传播,而不会对重要功能造成长期损害. 然而, transections in areas of the brain responsible for language may cause mild language impairments.
这种方法对于患有一种叫做兰多-克莱夫纳综合征的罕见癫痫的人来说尤其成功.
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, 进入我们的癫痫监测部门(EMU)并进行影像学检查,以帮助确定癫痫发作可能发生在大脑的哪个部位.
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),以便我们使用视频和脑电图(EEG)监测记录您的癫痫发作. 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, 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, 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, 脑磁图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大脑功能和结构的视图.
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 monitoring. 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 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, 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
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.
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.