皮层脑电图监测在伴有癫痫的颞叶海绵状血管瘤手术中的作用  

Electrocorticography-guided resection of temporal cavernous malformations associated with epilepsy

作　　者：王逸鹤[1] 赵国光[1] 单永治[1] 樊晓彤[1] 安阳[1] 

机构地区：[1]首都医科大学宣武医院神经外科,北京100053

出　　处：《中国临床神经外科杂志》2016年第8期463-465,共3页Chinese Journal of Clinical Neurosurgery

摘　　要：目的 探讨皮层脑电图（ECo G）监测在伴有癫痫的颞叶海绵状血管瘤手术中的作用。方法 2006年1月至2015年3月手术治疗伴有癫痫的颞叶海绵状血管瘤98例,术中采用ECo G监测53例,未用ECo G监测45例。术后随访1~8年,平均3.5年。结果 术后无死亡及永久性功能障碍。术后EngleⅠ级72例（73.5%）,Ⅱ级18例（18.4%）,Ⅲ级5例（5.1%）,Ⅳ级3例（3.1%）。癫痫病史〈1年的36例中,术后EngleⅠ级31例（86.1%）;〉1年的62中,术后EngleⅠ级41例（66.1%）;两组差异显著（P〈0.05）。ECo G监测下手术的53例中,术后EngleⅠ级44例（83.0%）;未监测的45例中,术后EngleⅠ级28例（62.2%）;两组亦差异显著（P〈0.05）。结论 伴有癫痫的颞叶海绵状血管瘤应尽早手术治疗;在ECo G监测下做病灶扩大切除或脑叶切除将获得更理想的癫痫控制率。Objective To explore the value of electrocorticogram （ECoG） to neurosurgery for temporal lobe cavernous malformations （CMs） associated with epilepsy. Methods The clinical data of 98 patients with temporal lobe CMs associated with epilepsy who underwent neurosurgery from January, 2006 to March, 2015 were analyzed retrospectively. Of 98 patients, 53 （observed group） received ECoG-guided resection of CMs and hemosiderin zone along with extended epileptogenic zones and the 45 （control group） underwent resection of CMs and hemosiderin zone without ECoG guide. All the patients were followed up for 1 year at least. Results CMs were confirmed by pathological examination in all the patients, in whom no permanent neurological dysfunction was observed during following-up. The epileptic control reached Engle class Ⅰ in 72 patients （73.5%）, Ⅱ in 18 （18.4%）, Ⅲ in 5 patients （5.1%） and Ⅳ in 3 （3.1%）. The percentage （86.1%, 31/36） of the patients with Engle Class I was significantly higher in the patients with fewer than 1 year preoperative duration of seizures than that （66.1%, 41/62） in the patients with more than 1 year preoperative duration of seizures （P〈 0.05）. The percentage （83.0%, 44/53） of the patients with Engle Class I was significantly higher in the observed group than that （62.2%, 28/45） in the control group （P〈0.05）. Conclusion Patients with temporal CM associated with epilepsy should be treated as early as possible by surgery. ECoG-guided surgery for temporal CM can enhance the rate of epileptic control.

关 键 词：海绵状血管瘤 癫痫 颞叶 皮层脑电图 手术 

分 类 号：R742.1[医药卫生—神经病学与精神病学] R651.11[医药卫生—临床医学]