脳梁離断術の適応と予後

Patient selection and surgical outcome of corpus callosotomy on medically intractable epilepsies.

脳梁離断術の手術適応，手術結果，予後につき自験例47例の結果を含め，文献的考察を行った。脳梁離断術では術後に完全に発作が消失することは少なく，発作軽減の目的で行われる。転倒発作，強直発作，ミオクローヌス発作，非定型欠神発作が脳梁離断術の良い適応であり，60～70％の症例において発作が軽減された。脳梁離断範囲，発作型，発作初発年齢，手術時期，一側性病変の有無，重度精神発達遅滞の合併，術前後の脳波所見など未解決の問題も多いが，発作の軽減に加え，QOLの改善も得られることより，切除外科の適応とならない例ではより積極的に試みられて良いと思われた。

The criteria for patient selection and surgical outcome of corpus callosotomy were retrospectively reevaluated based on literatures and results of our series of 47 patients. Postoperative improvements were consistently observed as to abolishing or significantly reducing drop attacks with atonic and tonic seizures, myoclonic seizures and atypical absences. Although only a small portion of patients became seizure free, and therefore the procedure might be palliative, significant reduction of seizure frequency and severity were consistently observed in 60-70% of patients.