难治性癫痫致痫灶的术前常用评估方法及有效性分析  

Common methods to evaluate refractory epilepsy preoperatively and their effects on localization of epileptogenic foci

作　　者：杜浩[1] 黄玲玥[1] 向露[1] 刘琴[1] 吕丽辉[1] 陈璐璐[1] 徐国政[1] 

机构地区：[1]中国人民解放军武汉总医院神经外科,武汉430070

出　　处：《中国临床神经外科杂志》2017年第4期224-227,共4页Chinese Journal of Clinical Neurosurgery

摘　　要：目的分析难治性癫痫致痫灶的术前常用评估方法的定位价值,为术前评估方法的合理选择提供依据。方法回顾性分析2011年9月至2013年10月手术治疗的76例难治性癫痫的临床资料,分别评估症状学、头皮及颅内脑电图、影像学检查在术前致痫灶定位中的有效性。结果分别有88.1%、44.7%、82.9%的病人通过临床症状学、头颅MRI、头皮脑电图监测可获得一定价值的定侧或定位信息;在难治性颞叶内侧癫痫中,手术侧海马头M:RS NAA/(Cr+Cho)比值较对侧明显降低(P<0.05),当双侧海马头NAA/(Cr+Cho)比值的不对称指数%0.08时,判断NAA/(Cr+Cho)比值较小一侧为致痫灶所在侧别的准确率更高。19例头颅MRI阴性并接受PET-CT检查的病人中,68.4%可获得一定价值的定侧或定位信息;仍有68.4%的病例需要通过颅内脑电图监测来进一步明确致痫灶的部位及范围。结论临床症状学分析及头皮脑电图监测对颅内电极的植入及致痫灶切除术有着重要的参考价值;MRI及MRS检查在难治性颞叶内侧癫痫的术前评估中存在一定的参考价值;PET-CT对于头颅MRI检查阴性的病例在癫痫手术中仍有着一定的参考价值;颅内脑电图监测对于致痫灶的判断及癫痫手术切除范围的限定仍有着决定性的意义。Objective To analyze common methods to evaluate refractory epilepsy preoperatively and their effects on localization of epileptogenic foci in order to provide reasonable method for preoperative evaluation of refractory epilepsy. Methods The clinical data of 76 patients with refractory epilepsy who underwent surgery from September, 2011 to October, 2013 in our department were analyzed retrospectively, including the effects of clinical symptoms, scalp and intracranial electroencephalogram （EEG） and imaging on the localization of epileptogenic foci and so on. Results The clinical symptoms, brain MRI and scalp EEG provided some useful information for localization and lateralization of epileptogenic foci before the surgery respectively in 88.1%, 44.7% and 82.9% of the patients with refractory epilepsy. N-acetyl-aspartaste （NAA）/[creatine（Cr）＋choline（Cho）] ratio in the unilaterally or bilateral hippocampal heads decreased in 33 patients accepting magnetic resonance spectroscopy （MRS）. In 20 patients with mesial temporal lobe epilepsy MRS （MTLE）, the NAA/（Cr＋Cho） ratio was significantly lower in the side with epileptogenic foci than that in the opposite side of cerebrum （P〈0.05）, but the epileptogenic foci were correctly located by the low NAA/（Cr＋Cho） ratio only in 12 patients. In 13 of 19 （88.4%） patients without structural abnormalities confirmed by MRI, positron emission tomography （PET） provided the certain information for the localization and lateralization of the epileptogenic foci. The epileptogenic foci were correctly localized by the intracranial EEG in 52 patients with refractory epilepsy before the surgery. Conclusions The clinical symptoms, brain MRI, scalp EEG, and PET can provide some useful information for the localization and lateralization of the epileptogenic foci before the surgery in the patients with refractory epilepsy. MRS may provide the information in some degree for the epileptogenic foci lateralization in the patients with MTLE. The intracra

关 键 词：难治性癫痫 术前评估 致痫灶 定位 

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]