皮层脑电图辅助立体定向下手术治疗颅内钙化灶引起的难治性癫痫  

Intra-operative electrocorticography assisted stereotaxy for intractable epilepsy by intracranial calcification

作　　者：郭效东[1] 王本瀚[1] 刘明辉[1] 陆卫风[1] 郝文明[1] 吴艳芝[1] 张长远[1] 熊家锐[1] 李经纶[1] 王振华[1] 赵鸽[1] 杨俊国[1] 任廷文[1] 

机构地区：[1]解放军第153医院全军神经外科中心,郑州450042

出　　处：《立体定向和功能性神经外科杂志》2012年第4期198-203,共6页Chinese Journal of Stereotactic and Functional Neurosurgery

摘　　要：目的研究立体定向下开放式手术联合术中皮层脑电图(ECoG)监测治疗颅内钙化灶性癫痫的手术方法、注意事项及效果。方法 21例颅内单发钙化灶引起的癫痫患者(其中主要功能区钙化灶9例),在立体定向仪导向下,开放直视手术,ECoG监测钙化灶周围皮层脑电活动情况,切除钙化灶后再次ECoG监测,确定致痫灶的范围及处理方式。结果所有钙化灶均被顺利切除。钙化灶区域ECoG监测无明显异常5例,表现为阵发性与动脉搏动相一致的单发性棘慢复合波发放9例,表现为明显癫痫样放电7例。单纯钙化灶切除术14例,钙化灶+周边增生组织+致痫皮层切除术4例,钙化灶切除+功能区致痫皮层低功率电凝热灼术3例。术后ECoG监测发现异常放电消失11例,仍残存轻中度痫样放电5例。无严重并发症。随访6个月～8年,EngelⅠ级16例,EngelⅡ级5例,总有效率100%。结论 ECoG监测是立体定向下手术治疗颅内钙化灶性癫痫的重要辅助手段,能够指导术中采取相应的手术方式切除钙化灶,妥善处理致痫灶,避免过多损伤脑皮层。Objective To investigate surgical method, announcements and efficacy of stereotactic craniotomy combining with intra-operative electrocorticography（ECoG） monitoring for intractable epilepsy by intracranial calcification. Methods Twenty-one patients with intractable epilepsy by intracranial single calcification （including 9 cases in functional areas） were performed by stereotactic craniotomy. The stereotaxy guide to resect calcification and locate epileptogenic focus and boundary by intra--operative ECoG monitoring, the epileptogenic focus were resected or performed cortex lower output powers thermocoagulation. Results All single calcification were resected successfully. Intrao-perative ECoG monitoring didn＇t discover apparent abnormality in 5 patients, ECoG showed a paroxysm singleness spike and slow wave complex firing corresponding with arteriopalmus before calcification was removed in 9 patients. ECoG showed obvious epileptiform discharge in 7 patients. Simple calcification was ablated in 14 cases, calcification plus peri-hyperplastic tissue plus cortex of epileptogenic focus were ablated in4 patients, calcification plus functional cortex of epileptogenic focus lower output powers thermocoagulation in 3cases. Postoperative ECoG monitoring found epileptiform discharge disappearance in 11 cases, residual abnormal EEG from mild to moderate in 5 cases. No permanency and severe complications were noted. All patients were followed up for six months to 8 years, according to Engel＇s classification standards, Engel I was noted in 16, Engel II in 5, and the effective rate was 100 %. Conclusion It is an important assisted means that intrao-perative ECoG monitoring combining with stereotactic craniotomy for intractable epilepsy by intracranial calcification. It can guide to adopt suitable approach resect calcification and make the best of epileptogenic focus, avoid damaging cortex excessively.

关 键 词：继发性癫痫 皮层脑电图 立体定向 钙化灶 致痫灶 

分 类 号：R742.1[医药卫生—神经病学与精神病学]