摘要
目的评价采用多种致痫灶定位方法联合手术治疗难治性继发性癫痫的效果、并发症、适应证。方法196例继发性癫痫患者，通过影像学检查、视频脑电图监测（VEEG）、癫痫发作症状学特点、正电子发射断层扫描（PET—CT）检查等方法综合判断致痫灶位置，术中皮层脑电图（ECoG）监测确定致痫灶的范围、神经电生理监测（IOM）定位功能区，辅助以麻醉唤醒定位语言区、实时超声检查病变切除程度、立体定向引导定位脑深部小病灶，根据监测结果分别采取病变组织切除及致痫灶切除术、多处软膜下横切术（MST）或皮层低功率电凝热灼术处理致痫灶。结果ECoG基本正常，行单纯病灶切除术29例；ECoG明显异常，在非功能区51例，行病灶＋周边致痫皮层切除术：ECoG明显异常而又在功能区79例，行病灶＋功能区致痫皮层MST或低功率电凝热灼术；深部电极监测发现杏仁核或海马异常放电37例，行前颞叶及杏仁核、海马切除术；辅助胼胝体前部切开术19例。术毕ECoG监测发现痫样放电消失、基本节律大致恢复正常76例，仍残留少量棘波48例，残存较多棘波且基本节律轻到中度异常43例。随访0．5—7．5年，有效随访177例，EngelⅠ级103例，EngelⅡ级45例，EngelⅢ级19例，EngelⅣ10例。总有效率94．3％。结论综合应用多种定位方法联合手术治疗继发性癫痫，能够准确定位并切除病灶及处理致痫灶，避免损伤功能区，是一种安全、有效的方法。
Objective To estimate surgical method, efficiency, complications and indications of comprehensive application of multiple epileptogenic foci location technique for refractory secondary epilepsy. Methods The 196 consecutive patients suffering from secondary epilepsy were subjected to operation. The epileptogenic foci and scope was localized by imageology, VEEG, symptomatology, PET-CT, intra-operative electrocorticography （ECoG） monitoring, function and the mapping of neuronal structures of epileptic region was judged by intra-operative neurophysiologic monitoring（IOM）, intra-operative language zone localization under arousal from drugged state, real- time ultrasound monitoring removal degree of focal lesion and stereotaxic apparatus-guided to resect small focal lesion in brain deep part. According to above the monitoring result epileptogenic foci were treated by resecting epileptogenic foci cortex, multiple subpial transaction （MST） and cortex lower output powers thermocoagulation respectively. Results ECoG was basic normal, simple focal lesion was total resected in 29 cases; ECoG were obvious abnormality and epileptogenic foci in non-domain, tbcal lesion plus perilesional cortex of epileptogenic foci were ablated in 51 patients; ECoG were obvious abnormality and epileptogenic foci in domain, focal lesion plus perilesional cortex of epileptogenic foci lower output powers thermocoagulation or/and MST in 79 cases. Deep electrode discovered amygdaloid nucleus and hippocampus paradoxical discharge in 37 cases, were subjected to anterior temporal lobectomy and amygdaloid- hippocampec-tomy; corpus callosotomy in 19 patients. Intra-operative ECoG monitoring discovered epileptiform discharge disappearance and basilic rhythm of EEG approximate recovery in 76 cases, still remaining a few spikes in 48 cases, remaining a lot of spikes as well basilic rhythm of EEG abnormal from light to midrange in 43 cases; 177 patients were followed up from 0.5 to 7.5 years, according to Engel＇s classification, 103 patients got Engel Ⅰ, 45 cases were EngelⅡ, 19 cases were Engel Ⅲ and 10 patients were Engel Ⅳ, the total effective rate was 94.3%. Conclusion It is a safe and effective management that surgical treatment for refractory secondary epilepsy by comprehensive using multiple epileptogenic foci location technique, which can accurate locate local lesion so that resect it completely and treat epileptogenic foci, avoid damaging functional areas.
出处
《实用医药杂志》
2012年第8期675-678,共4页
Practical Journal of Medicine & Pharmacy
关键词
继发性癫痫
皮层脑电图
立体定向
术中神经电生理监测
致痫灶
Secondary epilepsy
Electrocorticography （ECoG）
Stereotactic
Intra-operative neurophysiologicmonitoring（IOM）
Epileptogenic foci
