症状性枕叶癫痫术前致癎灶评估及疗效分析  

The surgical treatment and outcome for symptomatic occipital lobe epilepsy

作　　者：梅珍[1] 杨朋范[1] 范雅操 邱建东[1] 伍石挺 

机构地区：[1]南京军区福州总医院神经外科癫痫中心,福建福州350025

出　　处：《癫痫与神经电生理学杂志》2016年第5期257-259,271,共4页Journal of Epileptology and Electroneurophysiology(China)

摘　　要：目的：探讨36例症状性枕叶癫痫的术前评估和3年以上的随访结果。方法：采用长程视频脑电图（V—EEG）监测结合皮层脑电图（EEG）定位的方法，对症状性枕叶癫痫患者行术前评估方法，结合病理结果和手术疗效进行回顾性分析。结果：在36例症状性枕叶癫痫患者中，29例（81％）依据长程V—EEG和MRI等无创检查不能精确定位致痫灶，需应用颅内电极记录定位。对所有术后患者随访3年以上，Engel分级：Ⅰ级21例（58％）；Ⅱ级8例（22％）；Ⅲ级4例（11％）；Ⅳ级：3例（9％）。结论：症状性枕叶癫痫的临床特点包括：具有视觉先兆、枕叶区域异常EEG及影像学改变的症状性枕叶癫痫患者，结合V—EEG和皮层EEG监测，手术切除致痫灶能获得良好手术效果，特别是致痫灶病理为神经节胶质细胞瘤和胚胎发育不良性神经上皮肿瘤预后良好。Objective：To explore the presurgieal evaluation and the results of over 3 years follow-up in patients with symptomatic occipital lobe epilepsy（OLE）. Methods：From 2008 to 2013,36 patients with symptomatic OLE underwent noninvasive long-term video-EEG（VEEG）monitoring and invasive presurgi- cal evaluation intracranial EEG（IEEG）in our epilepsy center. Different resections were performed based on the results of standardized presurgical evaluation and IEEG monitoring. The methods of presurgical e- valuation,the feature of resection and the pathological results were analyzed. The clinical outcome was categorized and assessed according to Engel＇s classes in different follow-up periods. Results： Epileptogenic zones could not be located by standardized noninvasive presurgical evaluation in 29 patients with OLE （81% ） by intracranial electrodes out of 30 patients. The patients received 3 years follow-up after surgery. The follow-up showed that：Engel＇s Class Ⅰ was found in 21 patients（58% seizure free）,classes Ⅱ in 8 patients （22 % almost no seizure）, other classes （ Ⅲ and Ⅳ ） in 7 patients（ 19 % the frequency of seizure de- creased by 75%. Conclusion：The results indicate that patients with OLE are charactenzed by Visval aura and Occipital. Epileptiform discharges on scalp EEG, VEEG combined with IEEG. The outcome of surgi- cal treatment of symptomatic OLE is excellent. Pathological result of resection of the epileptogenic zone is desirable,and especially the prognosis of ganglioglioma and dysembryoplastic neuroepithelial tumor is rather good.

关 键 词：枕叶癫痫 颅内电极 脑电图(EEG) 手术治疗 

分 类 号：R742.1[医药卫生—神经病学与精神病学]