以癫痫为主的幕上肿瘤患者术前动态脑电图与术中皮层脑电图的对比研究  

Comparison of the presurgical scale ambulatory electroencephalogram and the electrocorticography in epileptics with supratentorial tumor

作　　者：但炜[1] 唐文渊[1] 刘福英[1] 

机构地区：[1]重庆医科大学附属第一医院神经外科,重庆400016

出　　处：《重庆医科大学学报》2008年第12期1458-1463,共6页Journal of Chongqing Medical University

基　　金：重庆帀卫生局资助项目(面上:05-2-167)

摘　　要：目的:通过与皮层脑电图(Electrocorticography,ECOG)对比分析,探讨头皮动态脑电图(Ambulatory electroencephalogram,AEEG)在以癫痫为主的幕上肿瘤患者中的表现特点及对致痫灶的定位意义。方法:选择资料完整的124例以癫痫为主的幕上肿瘤患者,术前均行至少1次头皮AEEG检查,术中作ECOG监测。将发作间期ECOG异常放电分为Ⅰ型:无棘波。Ⅱ型:偶发棘波或棘慢波。Ⅲ型:频发棘波散在出现。Ⅳ型:多棘波或多棘慢波间隙暴发出现。Ⅴ型:广泛高幅棘尖波连续出现。以A、B、C、D、E分别表示与上述分类相对应的头皮AEEG异常放电类型,将二者进行分析比较。结果:(1)124例幕上肿瘤的癫痫患者,头皮AEEG有104例监测到异常放电,其阳性率为83.87%。其中ECOGⅡ型,Ⅲ型在头皮AEEG上易缺失(P<0.05)。(2)ECOG异常放电Ⅳ型最多,77例(62.96%),在头皮AEEG上有47例(61.04%)表现为D型,少数为C型。Ⅳ型与D型一致性高(P<0.01)。(3)额叶病变异常放电率及部位在头皮AEEG与ECOG上一致性较高,颞叶及顶病变头皮AEEG与ECOG均显示病灶前方异常放电较其它部位多,P<0.05;并分别有82.35%、80.88%异常放电在额及前颞出现。(4)头皮AEEG显示有19.35%病例在病灶对侧可见独立的异常放电,ECOG上显示该部分病例异常放电位于病灶的近中线侧。结论:(1)以癫痫为主的幕上肿瘤患者头皮AEEG异常放电阳性率低于ECOG。(2)头皮AEEG异常放电中C型、D型的定性及定位价值较大,与ECOG符合率较高。(3)头皮AEEG异常放电范围较ECOG广泛,但其出现的部位可提示ECOG中异常放电传导的方向。objective： To discuss the characteristics and localizing significance of presurgical scale ambulatory electroencephalo- gram（AEEG） in patients with supratentorial tumor by comparison their electrocorticography（ECOG）. Methods： 124 subjects were collected in our hospital. All patients were monitored by the scalp AEEG before surgeries and ECOG during oprating. The interictal epileptiform discharges of ECOG were divided into five catalogs. Ⅰ ：no spikes, Ⅱ ：isolated spikes. Ⅲ： repetitive spike-wave pattern. Ⅳ： intermittent spikes,polyspikes waves burst. Ⅴ ：continuous hyper-spikes and sharps. A,B,C,D and E were represented on the scalp AEEG which corresponded the above ECOG classification. Then AEEG and ECOG were analyzed. Results： （1）The scalp AEEG was abnormal in 83.87% of all subjects before surgery.Ⅱ type and Ⅲ type on ECOG did not appear easily on the scalp AEEG（P〈0.05）. （2）The most type on ECOG（62.96%）was Ⅳ type. In IV type, 47 cases showed D type （61.04%）and some showed C type and there was higher coherence with D type on the scalp AEEG（P〈0.01）.（3）There was higher concordance in the rate and parl of abnormal discharge in the frontal lobe both on the scalp AEEG and ECOG. In the temporal and parietal lobe tumors, abnormal discharges which appeared in front of tumors were more than those of other spots, P〈0.05. The abnormal discharges of 82.35% on ECOG and 80.88% on the scalp AEEG respectively appeared in frontal lobe and in the front of temporal lobe（4）The 19.35% abnormal discharges on the scalp AEEG appeared independently on contralateral hemisphere and these cases showed that their abnormal discharges were mainly located at near median side. Conclusions： （1） There were higher abnormal rate on ECOG than that on the scalp AEEG in patients with supralentorial tumor.（2）C type and D type have more value in localizing.（3）There were wider distribution of abnormal discharges on the scalp AEEG than on ECOG. But the spots of abnorm

关 键 词：幕上肿瘤 癫痫 头皮动态脑电图 皮层脑电图 

分 类 号：R741.044[医药卫生—神经病学与精神病学]