gyrectomy法にててんかん焦点を含めて全摘出し得た難治性向反発作を呈したtuberous sclerosisの1手術例

A case of tuberous sclerosis presenting intractable adversive seizure, successfully resected with the technique of “gyrectomy”

I．はじめに

　近年，画像診断の進歩とともにより精密なてんかん焦点の同定が可能となり，薬物治療のみでは発作が十分抑制できない難治性てんかんの中に外科的治療の適応となる症例が見い出されるようになってきた^1）．今回われわれは，薬剤抵抗性の難治性てんかんで発症したtube—rous sclerosisの症例に対し，外科治療を試み，術中皮質脳波にててんかん焦点を同定しsulcotomyによる“gyrectomy法^6）”を用いて焦点を含む脳回切除を行い，術後てんかん発作が消失した1小児例を経験したので，若干の文献的考察を加えて報告する．

We report a 9-year-old girl with tuberous sclerosis presenting intractable adversive seizure. She had been suffering from frequent attacks of consciousness loss since the age of 6 years. Although a considerable amount of antiepileptic drugs had been administered,her epileptic attacks were not controlled, but instead rather increased. She had been suffering from adversive seizure to the right for more than 2 years. CT scan failed to show any abnormal density area. MRI showed a small lesion in the left frontal subcortical area. The electroencephalogram showed relatively mild abnormal waves in the left hemisphere. We undertook surgical re-moval of the lesion with epileptogenic foci because her epilepsy has not been controlled and the lesion could be a glioma. Abnormal spike waves were detected around the lesion with electrocorticogram. “Gyrectomy” techni-que was employed and the spike waves totaly dis-appeared. After the surgery, no neurological deteriora-tion was presented. She has suffered no seizure attack since the surgery even though the amount of the anti-epileptic drugs has been significantly decreased. Resec-tion of the epileptogenic foci as well as the abnormal lesion using the technique of gyrectomy is useful for the control of the intractable epilepsy, and makes the quality of life of patients much higher.