额颞癫痫术前评估脑磁图与神经导航应用研究
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摘要
目的研究脑磁图(MEG)与神经导航在额颞癫痫术前评估中的应用。方法选取手术治疗32例额颞癫痫患者临床资料分析。患者术前行致痫灶定位和智商、记忆和语言评估;MEG确定语言、记忆优势半球,明确语言功能区范围和记忆功能情况。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痫灶,保护神经功能。术后1年复测智商、记忆和语言检查,统计分析手术前后数据。癫痫术后随访13～41个月,平均(24.7±3.61)个月,依照Engel's分级标准,判定癫痫术后疗效。结果 32例额颞癫痫患者MEG检查顺利。MEG能够精确定位语言功能区位置。其中22例语言优势半球为左侧,10例在右侧。术后1年复测智商、记忆和语言,统计显示言语智商与总智商提高(P<0.05),记忆商、操作智商无明显变化(P>0.05)。患者术后恢复良好,无语言、记忆及肢体功能损伤。癫痫疗效:Engel'sI级15例,Engel'sⅡ级14例;Engel'sⅢ级3例。结论 MEG联合神经导航对于额颞癫痫患者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、避免严重术后并发症,提高癫痫手术疗效具有重要价值。
Objective To study the application of magnetoencephalogramy(MEG) combined with neuronavigation in the preoperative assessment of frontal temporal epilepsy. Method The clinical data of 32 patients of frontal temporal epilepsy were retrospectively analyzed. The location of epileptogenic focus and IQ,memory and language assessment of patients before operation.The MEG determine the language and memory dominant hemisphere, and clarify the scope and memory function of language function areas. The surgical navigation system of medtronic steal health was used to guide surgical resection of lesion and epileptogenic focus, and to protect nerve function. IQ, memory and language examination were measured 1 year after operation. The data were analyzed before and after operation. The patients were followed up for 13-41 months after operation, according to Engel's classification, the effect of epilepsy surgery was evaluated. Results The MEG examination was successful in32 patients of frontal temporal epilepsy. MEG can accurately locate the position of language function area. Of the 22 cases, the dominant hemisphere was left, and 10 cases were on the right. The statistic data showed that the verbal IQ and total IQ increased(P<0.05) in 1 year after operation, and there was no significant change in memory quotient and operation IQ(P>0.05). The patients recovered well after operation without language, memory and limb function injury. The effect of epilepsy surgery: 11 cases of Engel's Ⅰ grade, Engel's Ⅱ grade 17; 4 cases of Engel's Ⅲ grade.Conclusion MEG combined with neuronavigation has important value in the determination of the side, location and operation plan of the superior hemisphere of the patients of frontal temporal epilepsy, to protect the cortical function, to avoid serious postoperative complications and to improve the effect of epilepsy surgery.
Objective To study the application of magnetoencephalogramy(MEG) combined with neuronavigation in the preoperative assessment of frontal temporal epilepsy. Method The clinical data of 32 patients of frontal temporal epilepsy were retrospectively analyzed. The location of epileptogenic focus and IQ,memory and language assessment of patients before operation.The MEG determine the language and memory dominant hemisphere, and clarify the scope and memory function of language function areas. The surgical navigation system of medtronic steal health was used to guide surgical resection of lesion and epileptogenic focus, and to protect nerve function. IQ, memory and language examination were measured 1 year after operation. The data were analyzed before and after operation. The patients were followed up for 13-41 months after operation, according to Engel's classification, the effect of epilepsy surgery was evaluated. Results The MEG examination was successful in32 patients of frontal temporal epilepsy. MEG can accurately locate the position of language function area. Of the 22 cases, the dominant hemisphere was left, and 10 cases were on the right. The statistic data showed that the verbal IQ and total IQ increased(P<0.05) in 1 year after operation, and there was no significant change in memory quotient and operation IQ(P>0.05). The patients recovered well after operation without language, memory and limb function injury. The effect of epilepsy surgery: 11 cases of Engel's Ⅰ grade, Engel's Ⅱ grade 17; 4 cases of Engel's Ⅲ grade.Conclusion MEG combined with neuronavigation has important value in the determination of the side, location and operation plan of the superior hemisphere of the patients of frontal temporal epilepsy, to protect the cortical function, to avoid serious postoperative complications and to improve the effect of epilepsy surgery.
引文
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[12]郭韬,梁传栋,吴育锦,等.脑磁图联合DTI对大脑半球萎缩继发癫痫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.
[13]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.
[2]李新宇,张伟,鲁杰.癫痫患者认知功能障碍及康复策略[J].中华物理医学与康复杂志,2013,35(3):233-234.
[3]郭韬,张波,武江,等.药物难治性额叶、颞叶癫痫患者认知功能评估及影响因素对照分析中华神经医学杂志[J].2014,15(10):1004-1010.
[4]Piazzini A,Chifari R,Canevini MP,et al.Levetiracetam:an improvement of attention and of oral fluency in patients with partialepilepsy[J].Epilepsy Res,2012,68(3):181-188.
[5]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.
[6]Lindsay AJ,Rush SZ,Fenton LZ.Pediatric posterior fossa ganglioglioma:unique MRI features and correlation with BRAFV600E mutation status[J].J Neurooncol,2014,118(2):395-404.
[7]Passarelli V,Pinto L F,Jorge C L,et al.The intracarotidetomidate Wada test:A 54-patient series[J].Epilepsy Behav,2014,39:73-77.
[8]Jehi LE,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,2014,128:55-65.
[9]VerrottiA D,Egidio C,Agostinelli S,et a1.Antiepileptic drug withdrawal in childhood epilepsy:what are the risk factors as sociated 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]Bauer P R,R eitsma J B,Houweling B M,et al.Can fMRI safely replace the Wada test for preoperative assessment of language lateralisation?A meta-analysis and systematic review[J].JNeurol Neurosurg Psychiatry,2014,85(5):581-588.
[12]郭韬,梁传栋,吴育锦,等.脑磁图联合DTI对大脑半球萎缩继发癫痫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.
[13]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.