颅内占位继发性癫癎周边脑皮质痫性放电范围临床探讨  

The discharge range with the secondary epilepsy in surrounding brain cortiex of intracranial space-occupying

作　　者：杨瑞金[1] 蒋秋华[1] 曾海兰[1] 刘祥璐[1] 唐知己[1] 黄锦庆[1] 张震宇[1] 冯开明[1] 刘窗溪[2] 

机构地区：[1]赣州市人民医院神经外科,江西赣州341000 [2]贵州省人民医院神经外科

出　　处：《癫痫与神经电生理学杂志》2013年第5期271-273,共3页Journal of Epileptology and Electroneurophysiology(China)

摘　　要：目的：探讨颅内占位继发性癫癎病例大脑病灶周边脑皮质癎性放电范围，指导手术入路及切除范围，提高手术疗效的意义。方法：对36例继发性癫癎患者的头颅影像学、头皮脑电图（EEG）、术中皮层脑电图（ECoG）资料进行分析，指导切除病灶后对周边脑组织进行后续处理及处理的范围，术后随访，分析手术疗效。结果：手术治疗结果：本组无围手术期死亡病例，有短暂性肢体功能障碍7例，一过性失语3例，无永久性功能障碍病例。占位病灶周边脑皮质放电范围：9例≤1cm，22例〉1≤3cm，5例〉3cm。癫癎发作预后：对本组所有病例进行跟踪随访，Engel分级I级22例，Ⅱ级10例，Ⅲ级3例，Ⅳ级1例。结论：对于颅内占位继发癫癎病例，术中ECoG监测非常必要，占位周边存在痫性放电脑皮质，放电的范围大多为占位病灶外周1-3cm，其范围大小与占位病灶的病理类型、周围脑水肿程度、血流改变及局部物质代谢改变有关，手术暴露范围需相应扩大，以便术中EEG监测及对皮质的处理，提高总体疗效。Objective：To investigate the discharge range with the secondary epilepsy in surrounding brain cortiex of intracranial space occupying, and explove the surgical approach and extent of resection and to improve the effect of surgery. Methods：Secondary images of 36 patients with epilepsy, their scalp EEGs and intraoperative electrocorticograms（ECoGS） data were analyzed, guide the excision of the lesion and follow up the treatment and deal with the scope of the surrounding brain tissues. Postoperative fol- low up analysis of surgical effect was made. Results：There was no perioperative death; transient limb dys- function occurred in 7 cases, transient aphasia in 3 cases and no cases with permanet dysfuction. The oc- cupying lesions surrounding cortex discharge range.. 9 cases ≤ 1 cm, 22 cases〉 1 ≤ 3 era, 5 cases 〉 3 em. Engel classification in the prognosis of epileptic seizures： 22 cases were in Class Ⅰ ;10 cases in Class Ⅱ , 3 cases in Class Ⅲ ,one case in Class IV. Conclusion： Intraoperative ECoG monitoring of sec- ondary epilepsy during surgery is necessary for cases of intracranial space occupying; The cerebral cortex with epileptic discharge exists around the placeholder. Most of the discharge ranges for space occupying lesions occur in the outer periphery of 1-3 cm, and its scopeis are related to the change in size of the space occupying lesions histological type, surrounding brain edema,blood flow and local metabolism. Sur-gical exposure of the range should be expanded accordingly,in order to improve intraoperative ECoG mo- nitoring, processing of the cortex, and overall efficacy.

关 键 词：颅内占位 癫癎 手术治疗 皮层脑电图（ECoG） 放电范围 

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]