難治性てんかんに対する大脳半球切除術と大脳半球離断術(<特集>てんかん外科)  [in Japanese] Hemispherectomy and Hemispherotomy for Intractable Epilepsy(<SPECIAL ISSUE>Epilepsy Surgery)  [in Japanese]

大脳半球切除術や大脳半球離断術は,半球性てんかん焦点に対して大きな効果が期待できる治療法である.手術適応,手術成績,術式の歴史的変遷を概説するとともに,その最新術式である大脳半球離断術の手術解剖と手技を解説した.半球離断術における離断要素は,脳梁と投射線維とに大別される.おのおのの離断における複数の手技を,離断完全性や髄液循環障害発生率の観点から比較し,それらの長所短所を明らかにするとともに,各手技におけるわれわれの工夫を紹介した.

Hemispherectomy and its modifications are the most effective treatment for intractable epilepsy with hemispheric foci. In this article, those procedures were historically overviewed, and then the anatomical background and surgical techniques of the latest modification, hemispherotomy, were illustrated along with our refinements. The major anatomical components to be disconnected in hemispherotomy are the corpus callosum and the projection fibers. For each, we compared the approaches we adopted. The interhemispheric callosotomy enabled more reliable disconnection of the callosal fibers than transventricular callosotomy and was especially advantageous for anomalous and asymmetric callosum frequently found in hemimegalencephaly. Transopercular disconnection of the projection fibers overcame the problems encountered in peninsular disconnection but resulted in a higher occurrence of impaired CSF circulation. Reviewing these results we recently adopted vertical hemispherotomy for use with our modification.