摘要
目的探讨利用立体定向技术,辅助皮层电极监测,开放显微手术切除导致顽固性癫痫的脑内海绵状血管瘤,提高微创手术的治疗效果。方法26例顽固性癫痫病例,MRI示脑内海绵状血管瘤(直径在0.5～2.5cm),视频脑电图检查诊断与MRI定位一致。10例采用常规显微手术切除,16例利用立体定向技术,放置硅胶管引导显微手术切除病灶,辅助皮层脑电图监测确认致痫灶切除。结果手术时间:常规组为3.5小时,定向组为2.3小时。病灶全切率:常规组80%(8/10),定向组93.7%(15/16)。全部病例得到随访,时间平均18个月,常规组癫痫消失8例,脑电图记录到癫痫波2例,临床癫痫发作2例。定向组癫痫消失14例,脑电图记录到癫痫波2例,临床癫痫发作1例。结论在没有导航系统的条件下,立体定向引导显微开放手术,辅助皮层电极监测,切除以顽固性癫痫为症状的海绵状血管瘤是一种定位精确、微创、安全、有效的方法。
Objective To explore the clinical value and technique of CT-guided stereotactic system assisted micro-surgery for epileptogenic cavernous angiomas of brain. Methods 26 cases of cavernous angiomas with uncontrolled seizures, 16 of them （stereotaxis group ） were operated in opening ,stereotactic micro.surgery by CT guidance and to apply the electrocorticography （ ECoG ）to record the spike wave before resecting the focus and record again after resecting it. If the ECoG still recorded spike wave,it was necessary to perform multiple subpial tran,sections or cortex thermocoagulation. The other 10 cases （compare group） were treated by general micro,surgery. Results Operating time is 3. 5h of compare group and 2.3h of stereotaxis group respectively. The total removed rate is 80% （8/10）of compare group and 93. 7% （15/16）of stereotaxis group. All cases were followed up from 7 months to 24 months. Seizure free cases in compare group is eight, 2 cases still have spike wave, and 2 patients still have seizure. Fourteen patients＇ seizure disappeared in stereotaxis group, and 2 cases still have spike wave, one still have seizure. Conclusion CT guided opening stereotactic microsurgical operation combined with ECoG is an accurate location ,minimal inva,siveness, effective method to resect cavernous angiomas with uncontrolled seizures.
出处
《立体定向和功能性神经外科杂志》
2007年第6期345-347,共3页
Chinese Journal of Stereotactic and Functional Neurosurgery
