单光子发射计算机断层扫描在脑软化灶导致癫伽玛刀治疗中的应用  

Application of SPECT in Gamma-knife therapy epilepsy due to encephalomalacia

作　　者：余军武 赵俊 栾金利 董先成 胡祥华 孙效刚 樊跃飞 

机构地区：[1]山东淄博万杰医院神经外科,255213

出　　处：《临床神经外科杂志》2006年第1期24-26,共3页Journal of Clinical Neurosurgery

摘　　要：目的探讨发作间期及发作期单光子发射计算机断层扫描(SPECT)在脑软化灶导致癫疒间的伽玛刀治疗中的运用。方法69例由脑软化灶导致癫疒间的患者行SPECT检查,只有发作间期放射性分布减低和发作期增高在同一脑区才被确认为致疒间灶,结合CT、MRI、EEG及临床表现,确定靶区。结果69例患者发作间期SPECT均见大面积血流灌注减低或缺失,发作期SPECT均见高血流灌注区。靶区体积为4.2～15cm3,平均为6.8cm3,靶区体积明显缩小。69例经伽玛刀治疗后随访2.1～10年,满意55例,显著改善及良好各3例,无效8例,有效率88.4%。结论伽玛刀治疗脑软化灶导致的癫疒间是有效的,而且无痛苦、无出血、无感染、无死亡、术后恢复快,其中以局限性发作效果最好;对脑软化灶导致癫疒间的患者行SPECT检查,只有发作间期放射性分布减低和发作期增高在同一脑区才被确认为致疒间灶;以上方法可明显缩小靶区体积。Objective To explore the application of interictal SPECT and ictal SPECT in Gamma-knife therapy epilepsy due to encephalomalacia. Methods 69 cases of epilepsy due to encephalomalacia underwent SPECT testing. Only the brain areas that distributing of radioactivity diminution in interictal SPECT, in the same time, distributing of radioactivity heighten in ictal SPECT should be sure of epilepsy focus. The target was comfirmed by the combination of CT, MRI, EEG and clinic. Irradiated the target with lower doses （ Center dose 18 ~ 20 Gy, Margin dose 9 -10 Gy）, thereinto 13 cases with psychotic symptom plus stereotactic amygdalotomy （Center dose 90-100 Gy, Margin dose 45-50 Gy） by the Gamma-knife system of ELEKTA Company in Sweden. Application of the Gamma plan software drew the outline of the section that be interested in, and figured out the volume of section automatically. Rnsults There were brain areas that distributing of radioactivity diminution in interictal SPECT in all 69 cases ,and there were brain areas distributing of radioactivity heighten in ictal SPECT in all 69 cases. The volumes of target were 4.2 - 15cm^3 ,average was 6.8 cm^3 ,the volumes of target shrank evidently. Follow-up was accomplished in 69 cases for a duration of 2.1-10 years. 55 cases were satisfactory, 3 cases were ameliorative remarkably, 3 were benign, 8 were useless, effective rate was 84.4%. Seizure disappeared completely in 49 cases, accounts for 71%. There were 49 cases focal seizure, in that 47 cases were satisfactory, accounts for 95.9%. There was no mortality and deformity. Conclusions Therapy epilepsy due to encephalomalacia by Gamma knife is effective evidently, furthermore no pain, no bleeding, no infection, no death, resume quickly. Focal seizure patients have best curative effect. Epilepsy due to encephalomalacia perform SPECT, only the brain areas that distributing of radioactivity diminution in interictal SPECT, in the same time, distributing of radioactivity heighten in ictal SPECT should be sure of epilepsy focus.

关 键 词：脑软化灶 癫痫 伽玛刀 发作间期SPECT 发作期SPECT 

分 类 号：R742.1[医药卫生—神经病学与精神病学]