Abstract: Objective To review the clinical diagnosis and treatment of 5 epileptic patients with failure of epilepsy surgery, to explore causes of failure, and to summerize related experiences and lessons. Methods Five cases (4 males and one female, age from 2 years and 7 months to 24 years) of epilepsy [3 cases with dysembryoplastic neuroepithelial tumor (DNT) and 2 cases with hippocampal sclerosis associated with cortical dysplasia (CD)] were reported. Failure of epilepsy surgery in 5 cases were retrospectively analysed. Results The causes of failed surgery for epilepsy in 5 patients were confirmed by reoperation. The causes of failure were related to incomplete removal of the lesion and (or) epileptogenic zone in 3 cases, incomplete removal of medial temporal lobe structure in one case, and epileptogenic zone localized wrong or not accurate in one case. Outcomes of reoperation with gama?knife treatment were satisfactory. Four cases achieved Engel Ⅰ, and one case with Engel Ⅲ. By the evaluation of Tan Qifu's standard, 4 cases were satisfactory, and only one case showed moderate improvement. Conclusion The causes of failed epilepsy surgery may be related to incomplete resection of epileptogenic lesion. After failure it is necessary to present second preoperative evaluation and to perform reoperation which may produce satisfactory effect.

Key words: Epilepsy, Recurrence, Reoperation

摘要： 目的 回顾5 例手术失败癫痫患者临床诊断与治疗经过，探讨失败原因，总结经验教训。方法与结果 5 例首次手术失败癫痫患者，男4 例，女1 例；年龄最小2 岁7 个月、最大24 岁。其中胚胎发育不良性神经上皮瘤3例，海马硬化伴皮质发育不良2例。首次手术失败原因分别为病灶和（或）致灶切除不完全（3 例）、颞叶内侧致灶切除不彻底（1 例）和致灶定位错误或欠精确（1 例）。均经再次手术联合抗癫痫药物或伽玛刀治疗获得较好预后，疗效评价达Engel 标准Ⅰ级者4 例，Ⅲ级者1 例；谭启富标准达满意者4 例，良好者1 例。结论 导致癫痫手术失败的原因可能与致灶切除不彻底有关。通过严格的术前评价施行再次手术不失为最佳纠正方法，并可获得良好效果。

关键词: 癫痫, 复发, 再手术