深部电极引导伽玛刀治疗颞叶内侧癫痫(附21例临床分析)  

Deep electrode-guided gamma knife surgery for mesial temporal lobe epilepsy

作　　者：孙君昭[1] 田增民[1] 吴朝晖[1] 杜亚楠[1] 胡勇[1] 张剑宁[1] 

机构地区：[1]中国人民解放军第二军医大学海军临床医学部海军总医院全军神经外科中心,北京100048

出　　处：《立体定向和功能性神经外科杂志》2011年第4期198-201,共4页Chinese Journal of Stereotactic and Functional Neurosurgery

摘　　要：目的探索深部电极引导伽玛刀治疗颞叶内侧癫痫的方法,初步评价治疗效果。方法治疗21例颞叶内侧癫痫患者,其中男性13例,女性8例,年龄18－59岁,平均34.2岁,病史3－20年,平均13.5年。用无框架立体定向机器人技术进行深部电极植入,并进行深部电极长程视频脑电监测。本组双侧植入5例,单侧植入16例,植入监测时间1－7天,平均监测2.2天。明确致痫灶后,安装头架,行头颅CT扫描定位,然后拔除深部电极,行头颅核磁扫描。对头颅CT与核磁进行融合,明确致痫灶接触电极的位置,进行伽玛刀治疗。治疗剂量：周边剂量8－13 Gy,平均9.8 Gy;中心剂量16－26 Gy,平均18.2 Gy;50%等剂量曲线。结果随访6－36个月,平均15个月,Engel＇s效果分级：Ⅰ级2例,Ⅱ级4例,Ⅲ级9例,Ⅳ级6例（Ⅰ－Ⅲ级为治愈及有效）。有效率为71.4%。手术并发症：颅内积气2例,1周后自行吸收。无其他手术并发症。结论颞叶内侧癫痫深部电极探测明确致痫灶后,应用CT及核磁融合技术,在深部电极引导下进行伽玛刀低剂量治疗,初步治疗结果满意。Objective To explore the guided methods of gamma knife treatment for mesial temporal lobe epilepsy under the guidance of deep electrode,and to assess treatment efficacy preliminarily.Methods 21 patients（13 men,8 women;mean age 34.2 years;range 18 to 59 years） with MTLE were treated with OUR-Rotating Gamma Knife,guided by deep electrode.Epilepsy history has 3-20 years,average 13.5 years.Deep electrodes were buried with frameless stereotactic robot technology and did monitoring by long-range video EEG.Bilateral buried： 5cases,Unilateral buried 16 cases,Buried in time 1-7days,average 2.2 days.After finding epileptogenic foci,installation of the frame,positioning by head CT scan,then removal of deep electrode,do MRI scan.Through headCT and MRI fusion,after finding epileptogenic foci contact electrode position department,the gamma knife treatment was performed.The marginal dose ranged from 8 to 13 Gy（mean,9.8 Gy） and the prescription isodose was 50%.Results 21 patients were followed up from 6 to 36months（mean,15 months）.Engel＇s grade： grade Ⅰ：2 cases,gradeⅡ：4 case,grade Ⅲ：9 cases,grade Ⅳ：6 case,Ⅰ - Ⅲ level are the cure and effective.This group has 71.4% efficiency.Surgical complications： 2 cases had intracranial pneumatosis,self-absorption 1 week later.No other complications occurred in these patients.Conclusion After deep electrodes clearly detected of epileptic foci in medial temporal lobe epilepsy,low-dose gamma knife treatment was performed under the guidance of deep electrode,through the application of CT and MRI fusion technology.Preliminary results are satisfactory.

关 键 词：深部电极 伽玛刀 颞叶内侧癫痫 

分 类 号：R742.1[医药卫生—神经病学与精神病学]