颅内电极在外科治疗难治性癫痫中的应用——附20例临床报道  

Usefulness of intracranial electrodes for epilepsy surgery in refractory epilepsy

作　　者：方赟[1] 姚一[1] 谭启富[2] 张小斌[1] 杨文洁[1] 江建东[1] 黄德志[1] 刘小伟[1] 王逢鹏[1] 

机构地区：[1]解放军第一七四医院神经外科,厦门361003 [2]南京军区总医院神经外科

出　　处：《立体定向和功能性神经外科杂志》2010年第4期204-209,共6页Chinese Journal of Stereotactic and Functional Neurosurgery

基　　金：南京军区科技创新项目(编号:07Z017)

摘　　要：目的探讨颅内电极在外科治疗难治性癫痫中的应用。方法男12例,女8例,无创检查均不能准确定侧、定位。采用硬膜下和(或)深部电极进行长程视频脑电监测,电极放置部位、数量根据发作症状学和无创检查结果确定,其中皮层条状电极16例,皮层条状电极+深部电极2例,皮层条状电极+栅状电极2例。其中7例于埋藏后第4～12天行慢性电刺激以定位皮层功能区和(或)诱发癫痫发作。结果本组20例埋藏后监测2～21天,平均8.6天;17例获得定侧定位,1例明确为双侧起源,2例因其它原因被终止监测而无法定侧定位;17例行切除性手术,1例行胼胝体前部切开术,术后无一例感染。对随访6个月以上的17例作评估,满意15例(88.2%),显著改善2例。结论颅内电极能够用于定侧定位致痫灶及脑功能区,从而提高手术效果、降低神经功能障碍的发生。Objective To explore the application of intracranial electrode for epilepsy surgery in refractory epilepsy.Methods 20 patients with refractory epilepsy,whose seizure onset were unable to be located by MRI,Video-sEEG and clinical characteristic,including 12 male and 8 female.All patients were performed long-term video-iEEG using subdural and/or depth electrodes.Cortex strip electrodes were used in 16 patients,both cortex strip electrodes and depth electrodes in 2 patients,and both cortex strip electrodes and grille electrodes in 2 patients.The placement and number of electrodes were determined according to the clinical characteristic and non-invasion examinations.7 of the patients were performed chronic subdural electrostimulation 4～12 days after operation to identify the eloquent area and/or induce clinical seizures.Results The EEG monitoring lasted from 2 to 21 days,average 8.6 days.17 patients could be located for ablative surgery,1 case was did corpus callosotomy,and 2 patients were stopped the monitoring without operation.There were no infection in all patients.There were 17 patients to be followed up above 6 months and collected complete data.The clinical outcome showed that patients were seizure free in 15 cases（88.2%）,and improved significantly in 2 cases.Conclusion Which intracranial electrodes to localize epileptogenic zones and function areas in selected patients is a safe and effective method,and they can increase the effect of operation and reduce the neurologic disability.

关 键 词：难治性癫痫 颅内电极 脑电图 

分 类 号：R742.1[医药卫生—神经病学与精神病学]