癫痫术中致痫灶切除前后脑电监测棘波减少的量化指标  

Estimation of spike wave reduction in electrocorticography for predicting the outcomes of epilepsy surgery

作　　者：侯小兵[1] 周铨[1] 王国福[2] 谢坚[1] 

机构地区：[1]佛山市第一人民医院神经内科,广东佛山528000 [2]佛山市第一人民医院神经外科,广东佛山528000

出　　处：《南方医科大学学报》2010年第10期2363-2365,共3页Journal of Southern Medical University

基　　金：佛山市重点科技攻关项目(200808018);佛山市卫生局科研立项课题(2010014)

摘　　要：目的探讨癫痫术中致痫灶切除前后脑电监测棘波减少的量化指标。方法采用NICOLET BMSI6000脑电描记系统,应用皮层电极,在致痫灶靶区皮层,对癫痫起源部位进一步精确定位,并记录60s内棘波数量,手术切除致痫灶,统计60s内棘波数量,如果较切除前均减少超过80%,终止手术;如减少有低于80%者,则在皮层脑电图监测下进行病灶扩大切除、胼胝体切开或多处软膜下横切(MST),统计60s内棘波数量,术后常规应用抗癫痫药物。结果分别于切除后和扩大切除术后即使行皮质脑电监测,显示棘波减少80%以上12例,其中4例非功能区海绵状血管瘤,瘤体切除后仍可见大量棘波,扩大切除周围皮质,棘波减少达到80%;3例功能区胶质瘤患者虽经MST后,棘波减少50%～80%;4例海马硬化术后,棘波减少不足80%。术后疗效评价,按照Engel分级评价为:Ⅰ级13例,Ⅱ级3例,Ⅲ级1例,Ⅳ级3例;术后疗效评;总有效者17例,有效率达85%。结论非颞叶癫痫术中脑电监测切除后棘波减少超过80%预示手术效果良好,否则提示预后不良;颞叶癫痫术中脑电棘波减少与预后无直接关系。Objective To investigate spike wave reduction in electrocorticography（EcoG） monitoring for evaluating the outcomes of epilepsy surgery.Methods The epileptogenetic lesions in the target cortex was localized accurately using an EcoG monitoring system in 20 surgical patients with intractable EP.The spike numbers within 60 s were recorded before and aftersurgical resection of the epileptogenic focus.In cases where the spike numberwithin 60 s was reduced by over80%after the resection,the surgery was terminated,otherwise extended lesion resection,corpus callosotomy or multiple subpial transection（MST） was carried out with ECoG monitoring,and the spike numberwithin 60 s was recorded.Antiepiletic drugs were routinely prescribed after the operations.Results Twelve patients ehibited a spike wave reduction by over 80% after resection or extended resection of the lesions,including 4 with cavernomas in the nonfunctional area,who showed a spike wave reduction by over80% afterextended resection of the cortex around the tumor.The redction was still less than 80% in 4 patients with hippocampal sclerosis and 3 with neurogliocytoma in the functional area after the operations.According to the Engel assessments,13 cases were in level I,3 cases in level II,1 in level III,and 3 in level IV.Seventeen patients responded favorably to the treatment,with a total effective rate of 85%.Conclusion Forextra-temporal lobe epilepsy,a postoperative spike wave reduction beyond 80% indicate favorable outcome of the surgery,ortherwise poorprognosis is expected.But in cases of temporal lobe epilepsy,no direct association is found between spike wave reduction and the prognosis of the patients.

关 键 词：癫痫 术中脑电监测 量化指标 

分 类 号：R742.1[医药卫生—神经病学与精神病学]