病灶切除

You may be evaluated for surgery if you:

• Have seizures that are not satisfactorily controlled by medication
• Have drop (atonic) attacks
• Have partial-onset (focal) seizures
• Have structural brain problems — such as benign 脑部肿瘤, 中风 or blood vessel malformations — that are causing seizures
• Are experiencing intolerable side effects from your seizure medication

评价

病人 being considered for surgery will undergo an extensive pre-surgical evaluation. 加州大学旧金山分校, this includes visits to the 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.

During the initial 诊所 visit, 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.

Monitoring and imaging tests

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 electroencephalogram (EEG) 监控. 病人 generally stay in the EMU for three to five days. This allows us to determine your particular type of 癫痫 and where your seizures may arise, if they originate in a single area of the brain.

In addition, you may undergo one or more of the following tests:

• 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. 加州大学旧金山分校, 宠物 technology is combined with 核磁共振成像 for better accuracy.
• 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. This harmless compound acts as a tracer, 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. This is very similar to the EEG, 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, 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 is available at only a few institutions in California, and UCSF has one the premier 梅格 laboratories in the U.S.

Neuropsychology testing

In addition to imaging tests, 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, memory and comprehension skills. 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. The testing is non-judgmental and done in a comfortable, 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.

Intracranial 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.

UCSF is one of a handful of medical centers in the U.S. to offer stereoelectroencelphalography (SEEG), a less invasive form of intracranial 监控, as well as the standard subdural grid. 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, the resection surgery is scheduled for the following week.

癫痫 surgery conference

Before deciding on treatment recommendations, a team of UCSF epileptologists, 神经外科十大赌博平台排行榜, 神经心理学家, advanced practice nurses, 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. After the conference, 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

During the resection procedure, 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, sedation is lightened during part of the procedure, 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.

Once the seizure focus is removed, the surgeon will replace the dura and bone and close the scalp using stitches or staples. The night of the surgery is spent in the intensive care unit. 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, if intracranial 监控 is required before surgery, 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. This usually goes away within four to six weeks after surgery.

You will have your stitches or staples removed 10 to 14 days after surgery, either at UCSF or at your local doctor's office.

Most patients experience headaches during the first few weeks after surgery. The headaches will gradually become less frequent and less intense. Other effects of the surgery may include decreased ability to concentrate, forgetfulness and word finding difficulties. In most cases, these problems gradually improve over the first few weeks.

It's common for patients to tire very easily after the operation, especially in the first few days after discharge from the hospital. 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. You will be tapered off of them two to three weeks after surgery. This can cause temporary withdrawal symptoms, 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, even if you're not having any seizures, unless your doctor instructs otherwise.

You will be given detailed post-operative instructions, as well as directions on how to contact the neurosurgery team with any questions or concerns, before you are discharged from the hospital.

For more information, please contact one of our 癫痫 nurse specialists:

神经学:
Maritza Lopez, (415) 719-7888

神经外科:
Mariann Ward, (415) 353-2347