立体定向融合影像技术在治疗脑动静脉畸形引发癫痫的定位作用  

The value of stereotactic cerebral angiography combined with MR imaging in the diagnosis and treatment for the intractable epilepsy associated with intracranial arteriovenous

作　　者：赵国光[1] F Cardinale M Cossu G Lo Russo 

机构地区：[1]首都医科大学宣武医院神经外科,北京100053 [2]Centrodell' Epilepssia,Ospedale Niguarda Ca'Granda,Mi-lano

出　　处：《中国脑血管病杂志》2005年第7期298-302,共5页Chinese Journal of Cerebrovascular Diseases

基　　金：国家留学基金委中国意大利政府互换奖学金项目20032004年度

摘　　要：目的探讨立体定向结合脑血管造影与MRI影像融合在治疗脑动静脉畸形引发癫痫时对脑功能区、脑内病变和致痫灶空间范围的定位作用。方法对17例患者采用Talairach立体定向系统,绘制脑皮质表面血管图,并与三维MRI成像进行融合,标注脑功能区并设计术前深部电极放置部位和手术方案。结果17例患者获得了清晰的立体脑血管造影与MRI图像,涉及手术部位包括额叶8例、顶叶6例、颞叶2例和枕叶1例。手术完整切除动静脉畸形。术后随访1年,8例未见癫痫发作。结论该技术可以保证术前准确定位病灶,有利于术中判断脑沟回和功能区,避免损伤皮质功能区和血管。Objective The epileptic surgery requires the precise definition and location of the epileptogenic zone or the focus of the lesion. For this purpose, we discuss the value of stereotactic cerebral vascular angiography combined with MR imaging in the diagnosis and treatment for the intractable epilepsy.Methods Using the Talairach stereotactic system, the mapping of the cerebral blood vessels coordinated were integrated with the 3D MRI. All intractable epileptic cases were reported by this method prior to plan the locations of the depth electrodes and to determine the surgical procedure. Among these cases, one medically refractory partial epilepsy with cavernoma was introduced in detail, and to introduce the characteristics of this protocol. Results Definite mappings of stereotactic cerebral angiography and 3D MRI were reestablished in 17 cases, the cerebral lobes involved were including: frontal 8, parietal 6, temporal 2 and occipital one case. The lesionectomy was performed in all cases related with different nidus location. The patients were received follow up observation at least one year postoperatively, No seizure occurred in 8 cases(Engle Ia+c). Conclusion This technique can help us to localize the epileptogenic zone correctly and precisely, to distinguish the normal cortical gyri and sulci and then protect them during the surgical procedure. Moreover, this method has the advantage in the treatment of epilepsy, especially when the small deep focus will be resected.

关 键 词：脑动静脉畸形 定位作用 融合影像技术 治疗 立体脑血管造影 立体定向系统 脑功能区 MRI成像 MRI图像 影像融合 定向结合 脑内病变 手术方案 放置部位 深部电极 手术部位 完整切除 术后随访 癫痫发作 定位病灶 致痫灶 血管图 

分 类 号：R743.3[医药卫生—神经病学与精神病学]