PDF(Pubmed)
Abstract：
Epilepsy surgery is a well-established treatment for drug-resistant epilepsy, with awake craniotomy being used in certain cases to remove epileptogenic foci while preserving crucial brain functions. We are presenting the first reported case from Pakistan of a 19-year-old woman who underwent awake epilepsy surgery to treat cortical dysplasia. She had a history of generalized tonic-clonic seizures since her childhood and was referred to our clinic due to an increase in seizure frequency. EEG and MRI identified the epileptogenic focus in the right parieto-temporal region. The patient underwent a neuro-navigation guided awake craniotomy and an excision of the epileptogenic focus in the right parieto-temporal region. The procedure was carried out using a scalp block and dexmedetomidine for conscious sedation, enabling the patient to remain awake throughout the surgery. Intraoperative mapping and electrocorticography were used for complex multidisciplinary care. Post-resection corticography showed no spikes along the resected margins. The patient was discharged without any complications and remained free of symptoms a year after the surgery. Awake epilepsy surgery is a viable option for removing epileptogenic foci while preserving vital cognitive functions. However, it is seldom used in low- and middle-income countries such as Pakistan. The successful outcome of this case underscores the need for greater awareness and availability of epilepsy surgery in resource-limited settings. Cost-effective measures, such as using small subdural strips for intraoperative localization, can be implemented.
摘要：
癫痫手术是耐药性癫痫的一种公认的治疗方法，在某些情况下使用清醒开颅术来去除癫痫灶，同时保留关键的大脑功能。我们正在介绍来自巴基斯坦的第一例报告病例，该病例是一名19岁的妇女，她接受了清醒的癫痫手术以治疗皮质发育不良。她从小就有全身性强直阵挛性癫痫发作的病史，并且由于癫痫发作频率增加而被转诊到我们的诊所。EEG和MRI确定了右侧顶颞区的癫痫灶。患者接受了神经导航引导的清醒开颅手术，并切除了右侧顶颞区的癫痫灶。使用头皮阻滞和右美托咪定进行清醒镇静，使病人在整个手术过程中保持清醒。术中标测和皮质脑电图用于复杂的多学科护理。切除后皮质造影显示沿切除边缘无尖峰。患者出院，无任何并发症，术后一年无症状。清醒癫痫手术是在保留重要认知功能的同时去除癫痫灶的可行选择。然而,它很少在巴基斯坦等低收入和中等收入国家使用。该病例的成功结果强调了在资源有限的环境中需要提高癫痫手术的认识和可用性。具有成本效益的措施，例如使用小的硬膜下条带进行术中定位，可以实施。
