颅内电极监测技术在癫痫外科中的应用  

Application of intracranial electroencephalogram monitoring in epilepsy surgery

作　　者：魏梁锋[1] 杨朋范[1] 王如密[1] 赵琳[1] 梅珍[1] 林巧[1] 

机构地区：[1]福州总医院神经外科

出　　处：《福州总医院学报》2009年第1期21-22,15,F0003,共4页Journal of Fuzhou General Hospital

摘　　要：目的:探讨颅内电极监测技术在难治性癫痫外科治疗中的应用价值。方法:对常规头皮脑电图及影像学等非侵袭性检查难以确定致痫灶的或致痫灶与重要功能区关系密切的难治性癫痫患者51例,采用开颅手术方式在怀疑脑区埋置颅内电极。术后行长程视频脑电监测确定致痫灶后,进行脑皮层电刺激功能区测定,再次手术行致痫灶切除。结果:硬膜下电极埋置50例,硬膜外电极1例。术后所有病例均记录到明确的发作间期异常放电和/或发作期脑电图变化。致痫灶切除术后效果Engel分级:Ⅰ级32例,Ⅱ级13例,Ⅲ级5例,Ⅳ级1例。头皮愈合不良3例,延长住院时间后治愈。无永久性神经功能缺失发生。结论:颅内电极监测可以精确定位致痫灶,皮层电刺激术对脑功能区定位可靠、方便。对于采用非侵袭性检查不能明确致痫灶,或致痫灶与重要功能区关系密切的难治性癫痫患者,颅内电极监测结合皮层电刺激术可以提高癫痫治愈率,并有效降低并发症发生率。Objective： To investigate the application value of intracranial electroencephalogram （EEG） monitoring in patients with intractable epilepsy. Method： Fifty - one patients with intractable epilepsy, whose seizure onsets were unable to be localized with preoperative noninvasive evaluation （including scalp EEG recording and MRI, et al） or whose epileptogenic zone was close to eloquent cortex, were evaluated by intracranial EEG. Intracranial electrodes were implanted on suspect encephalic regions by craniotomy for these patients. Long - term intracranial EEG monitoring and cortex electrical stimulation was postoperatively performed to determine epihptogenic zone and eloquent cortex. Then reoperation was performed to resect the epileptogenic zone. Results： Subdural electrodes were implanted in 50 patients, and epidural electrode in 1 patient. The ictal and interietal discharges were recorded in all patients. Clinical outcome showed that patients were seizure free in 32 eases （62.7%） , improved significantly in 13 eases （25.5 % ）, improved in 5 eases （9.8 % ）, and unimproved in 1 ease （2.0 % ） . Wound with bad healing occurred in 3 cases, healed by prolonging length of stay. There were no cases of permanent neurological deficit. Conclusion： Intraeranial EEG is effective for precise epileptngenie zone localization and cortex electrical stimulation is reliable and convenient for eloquent cortex localization. For patients with intractable epilepsy, whose seizure onsets were unable to be localized with noninvasive method or whose epileptogenic zone was close to eloquent cortex, application of intracranial EEG associated with cortex electrical stimulation can improve epileptic cure rate and decrease complication rate.

关 键 词：难治性癫痫 颅内电极 皮层电刺激 定位 

分 类 号：R742.1[医药卫生—神经病学与精神病学] R144[医药卫生—临床医学]