下丘脑错构瘤癫的射频毁损治疗  

Radiofrequency ablation for intractable epilepsy caused by hypothalamic hamartomas

作　　者：林健[1] 王伟[1] 郭晓绯[1] 夏丽慧[1] 黎振声[1] 高曲文[1] 彭凯润[1] 王伟民[1] 王国良[1] 

机构地区：[1]广州军区广州总医院神经医学专科医院,510010

出　　处：《中国微侵袭神经外科杂志》2016年第4期154-156,共3页Chinese Journal of Minimally Invasive Neurosurgery

摘　　要：目的探讨下丘脑错构瘤所致癫病灶的射频毁损治疗方法及疗效。方法回顾性分析3例下丘脑错构瘤所致难治性癫病人的临床资料,癫发作类型为痴笑、复杂部分性或者继发全面强直阵挛发作。MRI均诊断为左侧第三脑室内的下丘脑错构瘤（DelalandeⅡ型）。均采用立体定向病灶射频毁损技术治疗。1例病人于定向射频术后3个月,经脑室内镜下再次行病灶射频毁损。结果立体定向瘤内植入的深部电极均记录到样放电。2例局麻下射频毁损时,出现体温快速升高、血压升高、心动过速、出汗等症状,治疗停止后消失。术后均无严重并发症。术后随访1～7年,Engel分级：Ⅰ级2例,Ⅱ级1例。结论采用立体定向或脑室内镜下射频毁损技术治疗DelalandeⅡ型的下丘脑错构瘤癫,可达到精准、安全、有效的目的。Objective To investigate the treatment and efficacy of radiofrequency ablation for hypothalamic hamartoma-related intractable epilepsy. Methods Clinical data of 3 patients with intractable epilepsy caused by hypothalamic hamartomas were analyzed retrospectively. Seizure types were gelastic and complex partial or secondary generalized tonic-clonic seizure. MRI showed hypothalamic hamartoma in the left wall of third ventricle（Delalande type Ⅱ） in all the patients, who underwent stereotactic radiofrequency ablation.Three months later, one patient was treated with radiofrequency ablation again via transventricular endoscopic approach. Results The intra-hamartoma depth electrode implanted by stereotactic radiofrequency showed epileptiform discharges in all the patients.Temperature rising fast, elevated blood pressure, tachycardia and sweating were observed in 2 patients during radiofrequency ablation under local anesthesia and these symptoms disappeared after treatment. No severe complication occurred after surgery. The postoperative follow-up period was 1 to 7 years. Engel grade Ⅰ was achieved in 2 patients and grade Ⅱ in 1. Conclusion The stereotactic or ventricle endoscopic radiofrequency ablation is a precise, safe and effective method for Delalande type Ⅱ hypothalamic hamartoma intractable epilepsy.

关 键 词：癫 下丘脑肿瘤 错构瘤 射频毁损 立体定位技术 内镜手术 

分 类 号：R739.4[医药卫生—肿瘤]