皮层脑电图监测与原发性难治性癫痫手术预后相关性分析  

Correlation between electrocorticogram and the prognosis of surgery for intractable epilepsy

作　　者：薛杉[1] 周谷兰[1] 张新伟[1] 郭燕舞[1] 张柳[1] 柯以铨[1] 

机构地区：[1]南方医科大学珠江医院神经外科 广东神经外科研究所,广州市510282

出　　处：《实用医学杂志》2010年第12期2074-2076,共3页The Journal of Practical Medicine

摘　　要：目的:探讨皮层脑电图(electrocorticography,EcoG)监测指导原发性难治性癫痫手术术式的价值。方法:114例原发性难治性癫痫患者在经过详细的术前评估后,进行了手术治疗。术中先行EcoG描记确定异常放电(interictal epilepiform discharge,IED)区域,切除癫痫病灶和(或)海马、杏仁核后再行EcoG描记,监测IED是否消失,若IED仍存在,则进一步切除颞极或加胼胝体切开术和中央前后回软膜下横切术,直至EcoG监测异常放电消失或明显减少。手术切除组织行病理检查。术后定期复查随访。结果:病理证实所有患者均符合原发性癫痫改变。术后随访6～48个月。根据ILAE疗效分级标准进行疗效评价。1级者52例,2级者21例,3级者17例,4级者16例,5级者3例,6级者5例,总有效率达到93.0%。结论:术中应用EcoG监测能有效地指导原发性难治性癫痫的手术。Objective To investigate the value of electrocorticogram （EcoG） monitoring in guiding the surgery of intractable epilepsy. Methods 114 patients with intractable epilepsy received operations after careful preoperative evaluation. During the operation, EcoG was firstly recorded to locate irritative zone. After the epileptic irritative zone and / or amygdaloid nucleus, hippocamp were resected, EcoG was recorded again to monitor whether abnormal discharges were disappeared, anterior temporal lobe can be resected or combined with corpus callosotomy according to the clinical manifestations of intraoperative EcoG. The tissues cut off were examined by pathology. Regular follow-up were performed. Results All patients were pathologically confirmed intractable epilepsy. The patients were followed-up for 6 to 48 months after surgery. The operation efficacy was evaluated according to ILAE classification standards. 52 cases were ILAE classⅠ, 21 cases ILAE classⅡ, 17 cases ILAE class Ⅲ, 16 cases ILAE class Ⅳ, 3 cases ILAE class Ⅴ, and 5 cases ILAE class Ⅵ. The total efficiency was 93.0%. Conclusions EcoG monitoring in epilepsy surgery may greatly improve the accuracy of spatial localization of irritative zone, and therefore guide the epileptic operation efficiently.

关 键 词：癫痫 皮层脑电图 异常放电 

分 类 号：R742.1[医药卫生—神经病学与精神病学]