Case Stusies

Liu Hengchen

Gender: Female

Age: 16 years

Admission condition:

The patient first experienced symptoms of epilepsy during daytime activities in November 2017 (at 10 years old), with no obvious trigger. She had another episode in January 2018, characterized by left eye deviation, leftward head and neck tilt, followed by falling, limb convulsions, clenched teeth, cyanotic lips, and altered consciousness. Subsequently, these symptoms recurred every 2-3 months. In the autumn of 2018, she sought medical attention at the Fifth People's Hospital of Zibo City, where a 24-hour EEG was conducted, confirming the diagnosis of epilepsy. During the diagnostic period, there was a day with multiple recurrent seizures. Over the past year, the frequency of seizures has slightly decreased, occurring once between March and June. All seizures occur during the daytime. The patient currently exhibits poor cognitive understanding, delayed reactions, unclear speech, irritability, and outward foot rotation while walking, but is generally able to carry out daily activities independently.

Admission Diagnosis: Epilepsy, intellectual disability

Treatment Process

Patient Liu Hengchen, female, 16 years old, underwent robot-assisted stereotactic brain surgery under general anesthesia on November 6, 2023, at 17:00. The main diagnoses were epilepsy, developmental delay, and intellectual disability. The surgical procedure involved placing markers on the head for CT scanning, which was then imported into the Remebot robot. The left temporal lobe was selected as the target point, and a surgical path was established through the left frontal region. The patient was positioned supine, and the head was immobilized and disinfected. Local scalp incision, drilling of skull holes, puncturing the dura mater with an electrode needle for brain tissue impedance testing, and implantation of EEG monitoring electrodes were performed. Upon identification of the epilepsy lesion, radiofrequency ablation was performed using a radiofrequency needle, followed by reinsertion of monitoring electrodes to ensure lesion disappearance. Subsequently, mild electrical stimulation was applied for nerve modulation therapy at the target site, completing the surgery on the left target point. The right internal capsule anterior limb was then selected as the target point, and a similar procedure was conducted through the right frontal region to complete the surgery on the right target point. The surgery proceeded smoothly with approximately 3ml of blood loss. Postoperatively, the needle was removed, and local skin closure and compression dressing were applied before transferring the patient back to the ward for observation.

Discharge Summary:

The patient's condition is currently stable, with the ability to engage in simple communication and activities. There is no bleeding or swelling at the surgical site, and no headache, nausea, or vomiting. The patient can tolerate a regular diet without coughing during meals, has normal urine output, clear consciousness, and good mental status, with physical examination findings unchanged from before. Healthcare personnel need to closely monitor the surgical incision, keep it dry, change dressings, and disinfect it on time. Precautions should also be taken to prevent falls and choking during meals. Continued close monitoring of the patient's condition is necessary, and if no abnormalities are noted during tomorrow's assessment, discharge may be considered.

Discharge Instructions:

1、Keep the wound dry after discharge and remove stitches after 5 days.

2、Rest well, avoid vigorous head movements, and strengthen protective measures.

3、Follow up with rehabilitation training based on the child's condition after discharge.

4、Seek medical attention promptly if there are any discomforts.