难治性癫痫的病灶定位及手术治疗研究  

Localization of epileptogenic zone and surgical management in patients with intractable epilepsy

作　　者：刘蓉[1] 朱明霞[2] 陈登奎[3] 庄进学[3] 

机构地区：[1]解放军第452医院神经内科,610021四川成都 [2]解放军第452医院癫痫中心,610021四川成都 [3]解放军第452医院神经外科,610021四川成都

出　　处：《癫痫与神经电生理学杂志》2012年第2期72-74,共3页Journal of Epileptology and Electroneurophysiology(China)

摘　　要：目的：探究难治性癫痫（intraclable epilepsy，IE）的病灶定位方法，以及皮层电极监测下将致痢灶切除或加皮层热凝术对1E的临床治疗效果，企为临床治疗IE提供新思路。方法：对2007年10月至2010年10月我院癫痫中心接收并确诊的62例IE患者采用头颅CT十头颅磁共振成像技术（MRI）＋视频脑电图监测（V—EEG）＋皮层脑电图（ECoG）＋深部脑电图（DEEG）联合对致痫病灶进行定位，55例（89％）检出致痴灶，在皮层双电极检测显微镜下将检出的致痫病灶切除；对于仍有痫样放电的患者加行皮层热凝术，但若致痢病灶位于重要功能区则单行皮层热凝术。结果：62例IE患者经CT＋MRI＋V-EEG＋ECoG＋DEEG联合检出致痫病灶者55例，经皮层电极监测显微镜下切除致痫灶并加行皮层热凝术后，52例患者术后癫痫发作停止，且未出现明显的并发症；3例（5％）患者半年后出现复发，但是表现出的症状明显较未行皮层热凝术术前轻，且癫痫发作持续的时间也明显较未行皮层热凝术术前变短。结论：CT＋MRI＋V-EEG＋ECoG＋DEEG联合监测能很好地对IE患者的致痫病灶进行定位；ECoG监测显微镜下切除致痫病灶加行皮层热凝术，对IE患者疗效确切：出血少、操作简便、安全省时、治愈率较高、术后的并发症少、复发率较低，能明显改善IE患者的生活质量，适合在临床推广使用。Objective：To evaluate the effect of a new localizational mode and lesionectomy of the epileptogenic zone under cortical electrode monitoring and/or cortex thermocoagulatlon so as to provide a new idea for clinical treatment of intractable epilepsy（IE）. Methods： The localizational mode of CI＋MRI ＋VEEG＋ ECOG＋DEEG was used in 62 patients with IE so as to increase the detection rate of the loci of IE, excision the epileptogenic zone under the microscope detection of cortical electrode monitoring. Both operations were performed under monitoring of intraoperative ECOG recording; for patients who discharged still in epileptiform,and cortex thermocoagulation was added;Cortex thermocoagulation was used when epileptic lesions laid in the important functional areas. Results：The epileptogenic zone were discovered in 55 patients with refractory epilepsy after CT＋ MRI＋ VEEG＋ ECoG＋ DEEG detection, 52 （95 %） patients＇ seizures stopped and no significant complications were detected after excision of epileptogenic zone and cortex thermocoagulation. Reduction of seizure frequency and severity recurred in 3 cases six months after operation. Conclusion.The localizational mode of CT＋MRI＋VEEG ＋ ECoG＋DEEG functions can increase the detection rate of the epileptogenic loci and has an important value in surgery. Lesionoectomy and cortex thermocoagulation under monitoring of intraoperative ECoG recordings have minimal damage, reliable effect, high rate of seizure free, time-saving and low rate of postoperative complications and recurrence,which can improve the quality of life of patients significantly and is suitable for clinical treatment.

关 键 词：难治性癫痫(IE) 致痫灶 定位 皮层热凝术 

分 类 号：R742.1[医药卫生—神经病学与精神病学] R741.044[医药卫生—临床医学]