术中皮层电极监测下显微外科手术治疗难治性癫痫
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摘要
目的：探讨难治性癫痫中运用皮质脑电图监测切除癫痫病灶的疗效。方法：对28例患者术前经多次常规脑电图、24h动态脑电图检查定位并联合CT、MR I或者fMRI、MRS及PET检查结果,确定癫痫病灶的准确位置。在皮质脑电图精确定位监测下手术切除致痫病灶。结果：28例难治性癫痫患者均通过皮质脑电图监测准确定位,切除致痫病灶后的棘波、尖波,棘、尖慢复合波减少或完全消失。按Engel术后效果分级：手术效果满意(癫痫发作消失)21例(75%),显著改善3例(10.8%),良好4例(14.3%),无效0例。结论：在癫痫手术中运用脑电皮层监测,可以进-步精确定位致痫灶,指导手术中正确切除癫痫灶及预示手术效果,有助于提高手术治疗的有效性,在癫痫外科治疗中具有一定应用价值。
Objective:To investigate the therapeutic effect on focal excision of epilepsy in intraoperative intractable epilepsy by electrocography (ECoG) monitoring Methods: 8patients with intractable epilepsy were examined by many times of routine EEG before operation,24h dynamic EEG, combined with examinations of CT and MRI, fMRI, MRS or PET, to confirm the accurate positions of epilepsy foci. The focal epilepsy were resected by electrocortography (ECoG) monitoring. Results:The focal excision of epilepsy of 28 patients was all successful, Spike waves, sharp waves complex were reduced or completely disappeared after focal excision of epilepsy. The clinical outcome showed that patients were seizure free in 21 cases (75%);improved significantly in 4 cases (10.8%);improved in 3 cases (14.3%);unimproved in 0 case according to Engel"s criteria after surgery. Conclusion:ECoG monoring during operation of EP can be effective in precise localization of epileptogenic zone, direction of the treatmet of EP by microsurgical and forecasting the curative effect.
Objective:To investigate the therapeutic effect on focal excision of epilepsy in intraoperative intractable epilepsy by electrocography (ECoG) monitoring Methods: 8patients with intractable epilepsy were examined by many times of routine EEG before operation,24h dynamic EEG, combined with examinations of CT and MRI, fMRI, MRS or PET, to confirm the accurate positions of epilepsy foci. The focal epilepsy were resected by electrocortography (ECoG) monitoring. Results:The focal excision of epilepsy of 28 patients was all successful, Spike waves, sharp waves complex were reduced or completely disappeared after focal excision of epilepsy. The clinical outcome showed that patients were seizure free in 21 cases (75%);improved significantly in 4 cases (10.8%);improved in 3 cases (14.3%);unimproved in 0 case according to Engel"s criteria after surgery. Conclusion:ECoG monoring during operation of EP can be effective in precise localization of epileptogenic zone, direction of the treatmet of EP by microsurgical and forecasting the curative effect.
引文
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[8]Zaknun JJ, Bal C, MaesA, et al. Comparative analysis of MR imaging, Ictal SPECT and EEG in temporal lobe epilepsy:a prospective IA EA multicenter study[J]. Eur J Notcl Med Mol Imaging,2008,35(1):1072-1075
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[10]栾国明.积极稳妥地开展癫痫外科手术[J].中华神经外科杂志,2002,18(4)：207-208
[11]张华,李波,姚庆和,等.长程颅内电极监测定位技术在癫痫外科中的应用[J].立体定向和功能神经外科杂志,2006,19(3)：142-145.
[10]Arango, Miguel F, et al. Neurosurgery for the t reatment of epilepsy[J]. Neuroanaest hesia 2004, pp 383-387
[12]栾国明,李云林,闫丽,等.痫灶切除辅助性脑皮质横行纤维热灼治疗功能区癫痫的临床研究[J].中华神经外科杂志,2002,18(4)：209-212
[13]吴立文.难治性癫痫的诊断和治疗[J].中华神经科杂志,2002,35(1)：55-57
[14]Commission on classification and terminology of the international league against epilepsy:Proposal for revised clinical and electroence phalographic classification of epileptic seizures[J]. Epilepsia,1981,22:489-501
[15]Commission on classification and terminology of the international league against epilepsy:Proposal for revised classification of epilepsies and epileptic syndromes[J]. Epilepsia,1989,30:389-399
[16]Ride S, Hifike P, Mothhesill IW, et al. Clinical observation to long term monitoring diagnostic development in conservative epileptology[J]. Epilepsia,2000, 41(suppl3):2.
[17]江澄川,余丽云,洪震.颞叶癫痫[M].第1版.上海：复旦大学出版社,2003：189-209
[18]Almeida A N, Martinez V, Feindel W. The first case of invasive EEG momtofing for the SOrsical treatment of epilepsy:historical significance and context[J]. Epilepsia, 2005,46(7):1082-1085
[19]Kuruvilla A, Flink R. Intraoperative electrocorticography in epilepsy surgery:useful or not?[J]. Seizure,2003,12(8):577-584
[20]Major P, Rakowski S, Simon M V, et al. Are cortical tubers epilepto-genie Evidence from electrocorticography[J]. Epilepsia,2009,50(1):147-154
[21]Nishida M, Juha. sz C, Seod S, et al. Cortical shcose metabolism positively correlates with gamma-oscillations in nonlesional focal epilepsy[J]. Neuroimage, 2008,42(4):1275-1284.
[22]Exner C, Boucsein K, LangC, et al. Neripsychological performance in frontal lobe epilepsy[J]. Seizure,2002, 11(1):20-32
[23]Wachi M, TomiKawa M, Fukuda M, et al. Neuropsychological changes after surgical treatment for temporal lobe epilepsy. Epilepsia 2001:42(Suppl 6)4-8.
[24]Klein B, Levin BE, Duchowny NS, et al. Cognitive outcome of children with epilepsy and malformations of cirtical development[J]. Nerology,2000, 25:55(2):230-5
[25]刘宗惠.癫痫外科治疗进展[J].华神经外科杂志,2000,16,增刊67-70
[26]孙振荣,栾国明,周建,等.多种手术结合治疗顽固性癫痫[J]中华神经外科杂志,2002,18(4)：219-221.
[27]侯晓华,林志国,浦松,等.顽固性癫痫病人术前综合评估在致痫灶定位中的应用[J].立体定向和功能性神经外科杂志,2004,17(2)：70-73
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[31]Buchhalter JR, Jarrar RG. Therapeutics in pediatric epilepsy, Part 2:Epilepsy surgery and vagus nerve stimulation[J]. Mayol Clin Proc,2003,78(3):371-378.
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[33]Trevathan E, Gilliam F. Lost years:delayed referral for surgically treatable epilepsy[J]. Neurology,2003,61(4):432-433
[34]Grajkowska W, Kotulska K, Matyja E, et al. Expression of tuberin and hamartin in tuberous sclerosis complexass ociated and sporadic cortical dysplasia of Taylor's balloon cell type[J]. Folia Neuropathol,2008,46(1):432-438
[35]Alons of Nanclares L, Garbelli R, Sola RG, et al. Microanatomy of the dys- plastic neocortex from epileptic patients[J]. Brain,2005,128(1):158-173
[36]Oh HS, LeeMC, Kim HS, et al. Pathophysiologic characteristics of balloon cells in cortical dys plasia[J].. Childs NervSyst,2008,24(2):175-183
[37]Englund C, Folkerth RD, Born D, et al. Aberrant neuronal glialdifferentiati on in Taylor type focal cortical dysplasia(type Ⅱ A/B)[J]. Acta Neuropathol,2005, 109(5):519-533
[38]Pmini A, Halasz P, Seheffer IE, et al. Reflex seizures in patients with malformations of cortical development and refractory epilepsy. Epilepsia,2005, 46(8):1224-1234.
[39]Chassoux F, Devaux B, Landre E, et al. Stereoelectroencephy in focal cortical dysplasia.. A3D approach to delineating the dysplastic cortex. Brain,2000, 12:1733-1755.
[40]蔡立新,李勇杰,张国君,等.局灶性皮质发育不良癫痫患者头皮脑电图的特点及其定位意义.临床神经电生理学杂志,2008-17-1.
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