术中颅内电极脑电监测在联合术式治疗顽固性癫痫中的应用  

Application of intraoperative intracranial EEG monitoring in multiple surgery on refractory epilepsy

作　　者：窦彩绘[1] 刘绍明[1] 

机构地区：[1]兰州军区乌鲁木齐总医院神经外科癫痫中心,新疆乌鲁木齐830000

出　　处：《癫痫与神经电生理学杂志》2010年第2期85-89,共5页Journal of Epileptology and Electroneurophysiology(China)

摘　　要：目的：探讨术中颅内电极脑电监测在癫痫外科手术中的应用方法及价值。方法：回顾分析难治性癫痫患者78例术中采用颅内电极脑电监测，在病灶切除前对致痫灶区行皮层电极描记，记录有无痼样放电和范围，对痫灶部位进一步精确定位。采用联合手术方法进行病灶切除，之后再次或多次描记，以判断痼样放电有无减少或消失，对有痫样放电的皮层再次进行软膜下横切术。术后常规应用抗癫痫药物。结果：78例患者，术前均在预定的致痫灶局部记录到棘波、棘慢波、尖波和尖慢波；致痢灶切除后即时监测结果显示其中有7例痫样放电完全消失，56例痫样放电明显减少、背景波幅降低，15例在病灶周围仍散在有明显痫样放电，经再次处理后减少，所有患者均无神经功能损害加重。78例患者均随访6个月至4年，多数患者生活质量提高、精神状态改善。其中发作消失51例（65％），发作明显减少（75％以上）16例（21％），发作减少（50％以上）7例（9％），发作无变化4例（5％）。总有效率为95％。结论：在癫痫外科手术中运用颅内电极进行脑电监测，能进一步明确致痂灶部位、监测异常波出现的范围及异常程度，指导手术中正确切除致痫灶，在癫痫外科治疗中具有一定的实用价值。Objective：To investigate the method and significance of intraoperative intracranial EEG monitoring in refractory epilepsy surgery. Method： Retrospective analysis of 78 patients with refractory epilepsy charged and undergone surgical treatment EEG monitoring was used in the surgery. Cortical elec troencephalogram （ECoG） traced the epileptic waves and its distribution in the planed surgical field be fore and after tailored resection to localize the epileptogenic loci accurately and desicle whether epileptic discharge were reduced or disappeared. The multiple subpial transection was used to treat remained ab- normal discharges in the cortex. Routine antiepileptic medication was used after surgery. Results： Spike waves, spike-slow waves, sharp waves, or sharp-slow waves in all 78 cases were recorded before surger y. Postoperative EEG monitoring showed epileptic waves disappeared completely in 7 cases, decreased apparently in 56 cases with the background amplitude lowered. Apparent epileptic wave scattered around the focus after surgery in 15 cases. The remained epileptic wave was reduced by the retreatment. No neurological complication was found in all of the patients. After follow-up from 6 months to 4 years, the quality of life was improved in most patients, and the mental state was better. No seizure was found in 51 cases （65%）. Seizure was obviously reduced （〉75%） in 16 cases （21%）, decrease（〉50%）in 7 cases （9%）, no change in 4 cases （5%）. The total effective rate reached 95%. Conclusion： Intracranial EEG monitoring of epileptic loci in epilepsy surgery can further identify epileptic loci, monitor the region and the de gree of abnormal waves, and ensure the resectment and treatment of epileptic foci. It has a certain practical val ue in the surgical treatment of epilepsy.

关 键 词：顽固性癫痫 癫痫外科 颅内电极 脑电监测 

分 类 号：R742.1[医药卫生—神经病学与精神病学] R741.044[医药卫生—临床医学]