伽玛刀治疗顽固性癫间疒(附166例分析)  

Stereotactic Gamma knife for intractable epilepsy: report of 166 cases

作　　者：徐波涛[1] 梁军潮[1] 王伟民[1] 覃子衡[1] 吴鸿勋[1] 张聿浩[1] 李林[1] 周丽兰[1] 宁琼芳[1] 

机构地区：[1]中国人民解放军广州军区广州总医院神经外科,广东广州510010

出　　处：《中国微侵袭神经外科杂志》2007年第4期148-150,共3页Chinese Journal of Minimally Invasive Neurosurgery

基　　金：广东省自然科学基金资助(020667)

摘　　要：目的探讨伽玛刀治疗顽固性癫疒间的可行性。方法回顾性分析伽玛刀治疗166例顽固性癫疒间的结果,根据癫疒间发作特点、脑电图、PET-CT或脑磁图、CT或MRI进行致疒间灶定位。应用Leksell伽玛刀治疗,单纯以致疒间灶为靶点时,边缘剂量10～12 Gy,等中心曲线40%～60%。需加照射同侧杏仁核和海马时,边缘剂量16～20 Gy,等中心曲线40%～50%。结果随访6～96个月,平均58.5个月。Wieser癫疒间外科手术疗效分级:Ⅰ和Ⅱ级视作治愈,本组30.0%～37.6%;Ⅲ和Ⅳ级视作治疗有效,40.6～53.1%;Ⅴ和Ⅵ级视作治疗无效,15.7%～21.8%。发作频率术前为(5.1±2.9)次/月,术后12个月降至(1.1±0.8)次/月,随访结束时降至0.9次/月左右。主要并发症为放射性脑水肿,发生率5.4%,经对症治疗后均能缓解。结论伽玛刀治疗顽固性癫疒间效果良好,无严重并发症,可以作为顽固性癫疒间外科治疗的一种选择。Objective To evaluate the feasibility of stereotactic Gamma knife for intractable epilepsy. Methods The treatment outcomes of 166 patients with intractable epilepsy treated by Leksell Gamma Knife were retrospectively analyzed. The epileptogenic focus was localized by characteristics of epileptic seizure, EEG, PET-CT or magnetic encephalography, CT or MRI. Marginal dose of 10-12 Gy to isodose line of 40%-60% .was managed when target was pointed to the epileptogenic focus, and 16-20 Gy to 40%-50% was managed to the homolateral amygdala and hippocampos if necessary. Results The follow-up time were 6-96 months, averaging 58.5 months. 30%-37.6% was classified as Wieser grades Ⅰ and Ⅱ, which were regarded as cured, 40.6%-53.1% as grades Ⅲ and Ⅳ, as effective, and 15.7%-27.8% as grades Ⅴ and Ⅵ, as ineffective. The seizure frequency declined from （5.1±2.9） times per month before Gamma knife treatment to （1.1±0.8） times per month 12 months after treatment, and 0.9 per month till the end of the follow-up. The main complication was radiation-induced cerebral edema＇with an incidence rate of 5.4%, and relieved after symptomatic treatment. Conclusion Gamma knife is effective for intractable epilepsy with no serious complications, thus being regarded as a choice of surgical treatment for intractable epilepsy.

关 键 词：放射外科手术 癫癎 立体定位技术 

分 类 号：R651.1[医药卫生—外科学]