皮层脑电图监测在顽固性癫痫手术中的应用(附155例报告)  

Electrocorticogram-guided microsurgery for refractory epilepsy(report of 155 cases)

作　　者：王俊伟[1] 吴南[1] 兰川[1] 吴国材[1] 冯华[1] 

机构地区：[1]第三军医大学西南医院神经外科,重庆400038

出　　处：《中国临床神经外科杂志》2011年第12期708-710,共3页Chinese Journal of Clinical Neurosurgery

摘　　要：目的总结皮层脑电图在顽固性癫痫手术中的应用经验并评价手术疗效。方法155例顽固性癫痫患者，术前行MRI、视频脑电图、单光子发射计算机断层成像与脑磁图检查，明确致痫灶，在皮层脑电图监测下手术。54例颞叶癫痫患者行颞叶前部与海马杏仁核显微切除术，47例颅内病灶患者行病灶与癫痫灶切除术，35例行癫痫灶切除术，19例致痫灶位于功能区的患者行皮层电凝及软脑膜下横纤维切断术。结果术后随访1-2年，按Engel分级：Ⅰ级88例，Ⅱ级46例，Ⅲ级13例，Ⅳ级8例。术后患者神经功能保持良好，未出现明显后遗症。结论在术前多种方法联合定位癫痫灶的基础上，应用皮层脑电图可以提高顽固性癫痫患者的手术疗效。Objectives To summarize the clinical experiences in treating the refractory epilepsy by electrocorticogram-guided microsurgery and evaluate its curative effect on the refractory epilepsy. Methods Preoperative MRI, video electroencephalography, electroencephalography, single photo emission computed tomography and magnetoencephalography were performed in 155 patients with refractory epilepsy in order to locate the epileptogenous loci. All the operations were performed under the guidance of electrocorticography. Of 155 patients with epilepsy, 54 underwent anterior temporal lobeetomy and amygdalohippocampectomy, 47 the resection of the intracranial lesions and epileptogenic loci, 35 the resection of the epileptogenic loci and 19 the bipolar electrocoagulation on functional cortex and multiple subpial transection. Results All the patients were followed up from 12 to 24 months after surgery. Of 155 patients, 88 belonged in Engel class J , 46 in Engel class JJ, 13 in Engel class JJJ, and 8 in Engel class IV. Conclusion Electrocorticogram-guided surgery can enhance the curative effect of surgery on the refractory epilepsy on the basis of located epileptogenic loci by the preoperation examinations.

关 键 词：皮层脑电图 顽固性癫痫 手术 疗效 

分 类 号：R742.1[医药卫生—神经病学与精神病学] R651.11[医药卫生—临床医学]