Neurological Surgery 脳神経外科38巻3号

2010年03月発行

総説

難治性てんかんに対する脳神経外科手術の歴史と今後の展望

著者： 大槻泰介¹

所属機関： ¹国立精神・神経センター病院脳神経外科

ページ範囲：P.229 - P.241

Ⅰ．はじめに：てんかん外科とJackson-Horsley

　てんかんの外科治療は，Victor Horsleyが1886年にHughlings Jacksonにより紹介され手術を行った，部分運動発作を伴う外傷性てんかん患者に対する運動野近傍の瘢痕切除に始まるとされる³⁾．Jacksonは既にこの時代，部分てんかんが大脳皮質灰白質の“発射病巣（discharging lesion）”によることを認識しており^59,102)，Horsleyに手術を依頼した2例目では，結核腫を摘出した後，術中皮質電気刺激の結果に基づき“てんかん原性焦点（epileptogenous focus）”として拇指領域の運動野皮質の切除が追加されている³⁷⁾．Jacksonの“発射病巣”の概念は，その後“てんかん原性焦点”⁹⁴⁾，および“てんかん原性領域（epileptogenic zone）”⁵⁵⁾に引き継がれるが，Jackson-Horsley以来の120年間，てんかん原性領域をいかに同定し切除するかという課題が，てんかん外科の基本命題であり続けてきたと言える．

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