影像学难以确诊的额叶癫痫的诊断与定位  

To investigate the method of diagnosis and localization for negative imaging frontal lobe epilepsy

作　　者：郭韬[1] 孙吉林[1] 吴育锦[1] 杜亚丽[1] 

机构地区：[1]石家庄,河北省人民医院功能神经外科,石家庄050051

出　　处：《中华神经外科杂志》2013年第12期1224-1227,共4页Chinese Journal of Neurosurgery

摘　　要：目的探讨常规影像学难以确诊的额叶癫痫的诊断和定位方法，为手术治疗提供依据。方法回顾分析联合应用视频脑电图（VEEG）、脑磁图（MEG）、弥散张量成像（DTI）检查，诊断、定位并经手术证实为皮质发育不良（FCD）的28例常规影像学难以确诊的额叶癫痫患者的临床资料。结果VEEG显示棘波灶与FCD有很好的重叠性；阵发性或节律性的棘波活动高度提示FCD。MEG提示FCD位置及与功能区的关系，明确DTI感兴趣区（ROI）。DTl根据ROI的表观弥散系数图和部分各向异性图变化，确定常规影像学难以确诊的额叶癫痫的手术范围。28例癫痫患者行手术治疗，病理回报FCDIa型6例，FCDIb型9例，FCDIC型8例，FCDI／a型5例。全部患者术后随访12～26个月，平均17．3个月。EngelIa级7例，Ib级10例，Ⅱ级8例，Ⅲ级3例。结论联合应用VEEG、MEG和DTI技术可以准确诊断、定位常规影像学难以确诊的额叶癫痫，为精确切除致痫灶，提高额叶癫痫控制率提供保障。Objective To investigate the method of diagnosis and localization for negative imaging frontal lobe epilepsy, and provide the basis for the surgical treatment. Methods Retrospective analysis of the clinical data in 28 patients with diagnosis and localization for negative imaging frontal lobe epilepsy by video electroencephalogram （ VEEG）, magnetoencephalography （MEG） and diffusion trnsor imaging （ DT! ）, and FCD were proved by operation. Results The scope of FCD overlaps the area of spike wave by VEEG showed the area of spike wave with paroxysmal and rhythmicity that it would probably FCD. MEG indicate the relationship between FCD and functional cortex, also confirm regionofinterest of DTI. DTI can according to the changes of apparent diffusion coefficient map （ADC） and fractional anisotropy maps （FA）, determine the surgical treatment range of nonlesional frontal lobe epilepsy. 28 patients of epilepsy treated by operation, pathological report shows 6 cases of FCD type ] a, 9 cases of FCD type I b, 8 cases of FCD type I c, 5 cases of FCD type ]] a. All patients were followed up for 12 to 26 months, an average of 17.3 months. Engel [ grade A in 7 cases, 10 cases of Engd I grade B, 8 cases of grade II, 3 cases in grade ]U. Conclusions Combined application of VEEG , MEG and DTI technology can accurately diagnose and location for negative imaging frontal lobe epilepsy, they also guide the precise excision of epileptogenic focus and improve the control rate of frontal lobe epilepsy.

关 键 词：视频脑电图 脑磁图 弥散张量成像 局灶性皮质发育不良 诊断 定位 

分 类 号：R742.1[医药卫生—神经病学与精神病学]