摘要
目的探讨立体脑电图(SEEG)引导射频热凝毁损技术在下丘脑错构瘤继发癫痫治疗中的临床应用价值。方法回顾性分析2015年6月至2018年1月北京丰台医院神经外科接受SEEG引导射频热凝毁损治疗的7例下丘脑错构瘤继发癫痫患者的临床资料,包括详细病史、症状学、脑电图及影像学资料。术前评估考虑下丘脑错构瘤为致痫灶,随后利用立体定向框架于下丘脑错构瘤处植入SEEG电极,并行视频脑电监测,根据SEEG的放电区域进行射频热凝毁损术。若毁损后癫痫样放电未消失,则进行第二次毁损,直至癫痫样放电消失。分析术后并发症,并进行电话或门诊随访,应用Engel分级进行预后评估。结果7例患者热凝毁损术后的平均随访时间为(19.6±11.1)个月,其中5例患者的癫痫发作消失(Engel分级Ⅰ级),1例患者毁损术后的癫痫发作频率减少约75%(Engel分级Ⅲ级),1例患者毁损术后的癫痫发作频率未明显改善(Engel分级Ⅳ级)。3例患者术后早期出现高热、嗜睡、尿崩症、电解质紊乱及记忆力下降等并发症,经治疗后均恢复。结论本研究初步认为SEEG引导的射频热凝毁损术是治疗下丘脑错构瘤继发癫痫安全、有效的治疗手段。在诊断明确的前提下完全离断错构瘤基底与下丘脑的联系是癫痫控制的关键。
Objective To discuss the clinical application value of stereo-electroencephalography (SEEG)guided radiofrequeney thermocoagulation (RF-TC)in the treatment of hypothalamie hamartoma (HH)related epilepsy.Methods A retrospective analysis was conducted on the clinical data of 7 consecutive patients with epilepsy caused by HH who underwent SEEG guided RF-TC at Department of Neurosurgery,Beijing Fengtai Hospital from June 2015 to January 2018.The clinical data included detailed history of illness,semiology,electroencephalography (EEG)and imaging results.Presnrgical evaluation suggested that the epileptogenic zone was hypothalamie hamartoma.Then the SEEG electrodes were implanted using stereotactie frame and video EEG monitoring was conducted.Contacts with seizure onset patterns were chosen for ablation through RF-TC.After the ablation,video-EEG monitoring was still carried out.If the epileptic discharge did not disappear,the second RF-TC was carried out until the epileptic discharge disappeared.The postoperative complications were analyzed and post-operative seizure outcome was evaluated based on the Engel outeome classification at follow-up with telephone or clinical visits. Results Sevenpatients were followed up with a duration of 19.6±11.1 months.Among them,5 were seizure free (Engel Ⅰ)and 1achieved 75% decrease (Engel Ⅲ)in seizure frequency.One case had no obvious improvement (Engel Ⅳ).Postoperative complications occurred in 3 patients which included hyperthermia,lethargy,diabetes insipidus,electrolyte disorder and memory decline.All complications were resolved after treatment.Conclusion This study has suggested that SEEG guided RF-TC is an effective and safe treatment for seizure control in patients with HH.Complete disconnection between hypothalamus and hamartoma with RF-TC is essential for favorable surgical outeome.
作者
郑重
李冬智
宋杉
杨晓丽
马延山
桑林
Zheng Zhong;Li Dongzhi;Song Shan;Yang Xiaoli;Ma Yanshan;Sang Lin(Department of Neurosurgery,Beijing Fengtai Hospital,Beijing 100071,China)
出处
《中华神经外科杂志》
CSCD
北大核心
2018年第12期1227-1231,共5页
Chinese Journal of Neurosurgery
基金
北京市医院管理局“登峰”计划(DFL20150503)
北京市科学技术委员会(Z161100000216130)
北京市丰台区卫生计生系统科研项目(2016-28).
关键词
癫痫
立体脑电图
下丘脑错构瘤
射频热凝
Epilepsy
Stereoeleetroencephalography
Hypothalamic hamartoma
Radiofrequency thermocoagulation
