Wada试验联合神经导航在药物难治性额颞癫术前评估中的应用  

Application of Wada test combined with neuronavigation in preoperative evaluation of drug refractory frontotemporal epilepsy

作　　者：郭韬[1] 刘倩薇[1] 陈尧[1] 郭非[2] Guo Tao;Liu Qianwei;Chen Yao;Guo Fei(Department ofNeurosurgery,Hebei General Hospital,Shijiazhuang,Hebei 050051,China;Department of Rehabilitation,Second Hospital of Hebei Medical University,Shijiazhuang,Hebei 050000,China)

机构地区：[1]河北省人民医院神经外二科,石家庄050051 [2]河北医科大学第二医院康复科,石家庄050000

出　　处：《中国微侵袭神经外科杂志》2018年第7期305-309,共5页Chinese Journal of Minimally Invasive Neurosurgery

基　　金：河北省科技计划项目(编号:162777209);河北省科技成果推广课题(编号:20170248)

摘　　要：目的探讨Wada试验联合神经导航在药物难治性额颞癫术前评估中的应用。方法回顾性分析手术治疗的52例药物难治性额颞癫病人的临床资料。术前行脑磁图及Wada试验确定语言、记忆优势半球,明确语言功能区位置和记忆功能情况。术中应用美国Medtronic Stealhealth S7手术导航系统引导手术切除病变和致灶。结果 Wada试验定位结果:语言优势半球位于左侧38例,右侧14例;记忆优势半球位于左侧30例,右侧18例,双侧半球4例;记忆优势半球及非优势半球比较,记忆评分差异明显(P<0.05)。与术前比较,术后1年言语智商与总智商明显提高(P<0.05),记忆商、操作智商无明显变化(P>0.05)。术后随访16~44个月,平均29.8个月,EngelⅠ级27例,EngelⅡ级19例,EngelⅢ级6例。结论 Wada试验联合神经导航对药物难治性额颞癫病人术前语言和记忆优势半球的定侧、定位和制定手术计划,保护皮质功能、避免术后并发症、提高癫手术疗效具有重要价值。Objective To explore the application of Wada test combined with multimodal imaging neuronavigation in the diagnosis and treatment of drug refractory frontotemporal epilepsy（DRFE）. Methods Clinical data of 52 DRFE patients undergoing surgery were analyzed retrospectively. Magnetoencephalogram and Wada test were used to determine the dominant hemisphere of language and memory for confirming the position of language area and memory function before surgery. The American Medtronic Stealhealth S7 neuronavigation system was used to guide the surgical removal of lesions and epileptogenic foci. Results Wada test showed that left dominant hemisphere for language in 38 patients and right in 14, and left dominant hemisphere for memory in 30 patients, right in18 and bilateral in 4. There was a significant difference in memory score between the dominant hemisphere and non-dominant hemisphere（P〈0.05）. The verbal intelligence quotient（IQ） and total IQ obviously increased 1 year after surgery（P〈0.05）, but the memory IQ and performance IQ did not change significantly（P〉0.05）. The patients were followed up for 16 to 44 months with the mean period of 29.8 months, Engel grade Ⅰwas observed in 27 patients, grade Ⅱ in 19 and grade Ⅲ in 6. Conclusions For DRFE patients, Wada test combined with neuronavigation have great value for preoperative lateralization and localization of dominant hemispheres for language and memory, making surgical plan, protecting cortical function, avoiding postoperative complications and improving the surgical outcome of epilepsy.

关 键 词：癫[疒间] 难治性 药物 额叶 颞叶 WADA试验 神经导航 

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