Wada试验联合神经导航在药物难治性额颞癫术前评估中的应用
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摘要
目的探讨Wada试验联合神经导航在药物难治性额颞癫术前评估中的应用。方法回顾性分析手术治疗的52例药物难治性额颞癫病人的临床资料。术前行脑磁图及Wada试验确定语言、记忆优势半球,明确语言功能区位置和记忆功能情况。术中应用美国Medtronic Stealhealth S7手术导航系统引导手术切除病变和致灶。结果 Wada试验定位结果:语言优势半球位于左侧38例,右侧14例;记忆优势半球位于左侧30例,右侧18例,双侧半球4例;记忆优势半球及非优势半球比较,记忆评分差异明显(P<0.05)。与术前比较,术后1年言语智商与总智商明显提高(P<0.05),记忆商、操作智商无明显变化(P>0.05)。术后随访16~44个月,平均29.8个月,EngelⅠ级27例,EngelⅡ级19例,EngelⅢ级6例。结论 Wada试验联合神经导航对药物难治性额颞癫病人术前语言和记忆优势半球的定侧、定位和制定手术计划,保护皮质功能、避免术后并发症、提高癫手术疗效具有重要价值。
Objective To explore the application of Wada test combined with multimodal imaging neuronavigation in the diagnosis and treatment of drug refractory frontotemporal epilepsy(DRFE). Methods Clinical data of 52 DRFE patients undergoing surgery were analyzed retrospectively. Magnetoencephalogram and Wada test were used to determine the dominant hemisphere of language and memory for confirming the position of language area and memory function before surgery. The American Medtronic Stealhealth S7 neuronavigation system was used to guide the surgical removal of lesions and epileptogenic foci. Results Wada test showed that left dominant hemisphere for language in 38 patients and right in 14, and left dominant hemisphere for memory in 30 patients, right in18 and bilateral in 4. There was a significant difference in memory score between the dominant hemisphere and non-dominant hemisphere(P < 0.05). The verbal intelligence quotient(IQ) and total IQ obviously increased 1 year after surgery(P < 0.05), but the memory IQ and performance IQ did not change significantly(P > 0.05). The patients were followed up for 16 to 44 months with the mean period of 29.8 months, Engel grade Ⅰwas observed in 27 patients, grade Ⅱ in 19 and grade Ⅲ in 6. Conclusions For DRFE patients, Wada test combined with neuronavigation have great value for preoperative lateralization and localization of dominant hemispheres for language and memory, making surgical plan, protecting cortical function, avoiding postoperative complications and improving the surgical outcome of epilepsy.
Objective To explore the application of Wada test combined with multimodal imaging neuronavigation in the diagnosis and treatment of drug refractory frontotemporal epilepsy(DRFE). Methods Clinical data of 52 DRFE patients undergoing surgery were analyzed retrospectively. Magnetoencephalogram and Wada test were used to determine the dominant hemisphere of language and memory for confirming the position of language area and memory function before surgery. The American Medtronic Stealhealth S7 neuronavigation system was used to guide the surgical removal of lesions and epileptogenic foci. Results Wada test showed that left dominant hemisphere for language in 38 patients and right in 14, and left dominant hemisphere for memory in 30 patients, right in18 and bilateral in 4. There was a significant difference in memory score between the dominant hemisphere and non-dominant hemisphere(P < 0.05). The verbal intelligence quotient(IQ) and total IQ obviously increased 1 year after surgery(P < 0.05), but the memory IQ and performance IQ did not change significantly(P > 0.05). The patients were followed up for 16 to 44 months with the mean period of 29.8 months, Engel grade Ⅰwas observed in 27 patients, grade Ⅱ in 19 and grade Ⅲ in 6. Conclusions For DRFE patients, Wada test combined with neuronavigation have great value for preoperative lateralization and localization of dominant hemispheres for language and memory, making surgical plan, protecting cortical function, avoiding postoperative complications and improving the surgical outcome of epilepsy.
引文
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[8]BAUER P R,REITSMA J B,HOUWELING B M,et al.Can f MRI safely replace the Wada test for preoperative assessment of language lateralisation?A meta-analysis and systematic review[J].J Neurol Neurosurg Psychiatry,2014,85(5):581-588.
[9]VERROTTI A,D'EGIDIO C,AGOSTINELLI S,et al.Antiepileptic drug withdrawal in childhood epilepsy:what are the risk factors associated with seizure relapse[J]?Eur J Paediatr Neurol,2012,16(6):599-604.
[10]CUROT J,DENUELLE M,BUSIGNY T,et al.Bilateral Wada test:amobarbital or propofol[J]?Seizure,2014,23(2):122-128.
[11]JEHI L E,PALMINI A,ARYAL U,et al.Cerebral cavernous malformations in the setting of focal epilepsies:pathological findings,clinical characteristics,and surgical treatment principles[J].Acta Neuropathol,2014,128(1):55-65.
[12]PAPANICOLAOU A C,SIMOS P G,CASTILLO E M,et al.Magnetocephalography:a noninvasive alternative to the Wada procedure[J].J Neurosurg,2004,100(5):867-876.
[13]郭韬,李文玲,武江,等.脑磁图描记联合术中唤醒用于显微镜下切除功能区胚胎发育不良性神经上皮瘤[J].第二军医大学学报,2011,32(2):198-201.
[14]滕鹏飞,周健,翟锋,等.脑磁图在颞叶癫疒间诊断中的作用[J].中国微侵袭神经外科杂志,2018,23(1):44-48.
[15]郭韬,刘倩薇,陈尧,等.脑磁图联合弥散张量成像在常规磁共振成像阴性的额叶局灶性皮质发育不良术前评估中的应用价值[J].中国全科医学,2015,18(6):729-732.
[16]KUMAR A,CHANDRA P S,SHARMA B S,et al.The role of neuronavigation-guided functional MRI and diffusion tensor tractography along with cortical stimulation in patients with eloquent cortex lesions[J].Br J Neurosurg,2014,28(2):226-233.
[17]郭韬,梁传栋,吴玉锦,等.脑磁图联合DTI对大脑半球萎缩继发癫疒间患者术前功能区评估的价值[J].中华神经医学杂志,2014,13(9):919-924.
[18]崔建飞,梁树立.磁共振成像新技术在癫疒间术前评估的应用[J].中国微侵袭神经外科杂志,2017,22(11):518-520.
[2]PERUCCA E.Optimizing antiepileptic drug treatment in tumoral epilepsy[J].Epilepsia,2013,54(Suppl 9):S97-S104.
[3]郭韬,张波,武江,等.药物难治性额叶、颞叶癫疒间患者认知功能评估及影响因素对照分析[J].中华神经医学杂志,2014,15(10):1004-1010.
[4]DELING L,NAN J,YONGJI T,et al.Intraventricular ganglioglioma prognosis and hydrocephalus:the largest case series and systematic literature review[J].Acta Neurochir(Wien),2013,155(7):1253-1260.
[5]PASSARELLI V,PINTO L F,JORGE C L,et al.The intracarotid etomidate Wada test:a 54-patient series[J].Epilepsy Behav,2014,39:73-77.
[6]MCGILL M L,DEVINSKY O,WANG X,et al.Functional neuroimaging abnormalities in idiopathic generalized epilepsy[J].Neuroimage Clin,2014,6:455-462.
[7]周健,栾国明.颞叶癫疒间的外科治疗[J].中国微侵袭神经外科杂志,2018,23(1):1-5.
[8]BAUER P R,REITSMA J B,HOUWELING B M,et al.Can f MRI safely replace the Wada test for preoperative assessment of language lateralisation?A meta-analysis and systematic review[J].J Neurol Neurosurg Psychiatry,2014,85(5):581-588.
[9]VERROTTI A,D'EGIDIO C,AGOSTINELLI S,et al.Antiepileptic drug withdrawal in childhood epilepsy:what are the risk factors associated with seizure relapse[J]?Eur J Paediatr Neurol,2012,16(6):599-604.
[10]CUROT J,DENUELLE M,BUSIGNY T,et al.Bilateral Wada test:amobarbital or propofol[J]?Seizure,2014,23(2):122-128.
[11]JEHI L E,PALMINI A,ARYAL U,et al.Cerebral cavernous malformations in the setting of focal epilepsies:pathological findings,clinical characteristics,and surgical treatment principles[J].Acta Neuropathol,2014,128(1):55-65.
[12]PAPANICOLAOU A C,SIMOS P G,CASTILLO E M,et al.Magnetocephalography:a noninvasive alternative to the Wada procedure[J].J Neurosurg,2004,100(5):867-876.
[13]郭韬,李文玲,武江,等.脑磁图描记联合术中唤醒用于显微镜下切除功能区胚胎发育不良性神经上皮瘤[J].第二军医大学学报,2011,32(2):198-201.
[14]滕鹏飞,周健,翟锋,等.脑磁图在颞叶癫疒间诊断中的作用[J].中国微侵袭神经外科杂志,2018,23(1):44-48.
[15]郭韬,刘倩薇,陈尧,等.脑磁图联合弥散张量成像在常规磁共振成像阴性的额叶局灶性皮质发育不良术前评估中的应用价值[J].中国全科医学,2015,18(6):729-732.
[16]KUMAR A,CHANDRA P S,SHARMA B S,et al.The role of neuronavigation-guided functional MRI and diffusion tensor tractography along with cortical stimulation in patients with eloquent cortex lesions[J].Br J Neurosurg,2014,28(2):226-233.
[17]郭韬,梁传栋,吴玉锦,等.脑磁图联合DTI对大脑半球萎缩继发癫疒间患者术前功能区评估的价值[J].中华神经医学杂志,2014,13(9):919-924.
[18]崔建飞,梁树立.磁共振成像新技术在癫疒间术前评估的应用[J].中国微侵袭神经外科杂志,2017,22(11):518-520.