立体定向手术治疗功能区灰质异位所致难治性癫痫  

The stereotactic surgical treatment of patients with refractory epilepsy caused by eloquent cortex gray matter heterotopia

作　　者：郭效东[1] 刘明辉[1] 郝文明[1] 路小奇 杨俊国[1] 王振华 许鹏 熊家锐[1] 李经纶[1] 姚安会[1] 王本瀚[1] Guo Xiaodong;Liu Minghui;Hao Wenming(Department of Neurosurgery,153rd Hospital of PLA,Zhengzhou,450042)

机构地区：[1]解放军第153中心医院全军神经外科中心,郑州450042

出　　处：《立体定向和功能性神经外科杂志》2017年第6期321-325,共5页Chinese Journal of Stereotactic and Functional Neurosurgery

摘　　要：目的探讨立体定向颅内多靶点联合射频毁损手术治疗功能区灰质异位所致难治性癫痫的应用价值、手术方式、术后并发症及疗效。方法总结9例功能区灰质异位所致难治性癫痫立体定向手术病例,采用CT/MRI图像融合技术,手术计划系统确定颅内靶点,应用射频热凝对胼胝体、杏仁核、海马、Forel-H区、扣带回等多靶点组合毁损。术后长期随访,癫痫发作改善程度按Engel评价标准进行评定。结果随访时间4～8.5年,平均6.1年,Ⅰ级1例(11.1%),Ⅱ级2例(22.2%),Ⅲ级6例(66.6%)。术后出现一过性并发症8例,经对症治疗均在1～4周内恢复,无遗留永久性并发症。结论 CT/MRI图像融合辅助立体定向颅内多靶点联合毁损手术治疗功能区灰质异位所致难治性癫痫是一种安全、有效、微创的治疗方法。Objective To investigate the value,safety,efficacy and complications of stereotactic radiofrequency ablation of the intracranial association for refractory epilepsy caused by eloquent cortex gray matter heterotopia（GMH）.Methods 9 patients with refractory epilepsy caused by GMH were performed using stereotactic radiofrequency ablation were analyzed retrospectively.By MRI and CT image rebuilded and merged,operation planning system locating and combining intracranial target,for example corpus callosum,amygdaloid nucleus,hippocampus,Forel-H field and cingulate gyrus,these gargets were lesioned by stereotactic radiofrequency ablation.The clinical outcomes were assessed by evaluation criterion of Engel＇s class after operation.Results All of patients were followed up from 4-8.5 years（mean,6.1 years）normally,according to Engel＇s class,grade I in one case,grade II in 2 cases,gradeⅢin 6 cases.eight patients appeared temporary complications,but all complications got recovery from one to four weeks by symptomatic treatment,There were no severe permanent complications.Conclusion Stereotactic radiofrequency ablation of the intracranial multi-nucleus association by CT and MRI image rebuilded for refractory epilepsy caused by eloquent cortex gray matter heterotopia is safe,effective and microinvasive treatment.

关 键 词：灰质异位 难治性癫痫 立体定向 射频毁损 

分 类 号：R742.1[医药卫生—神经病学与精神病学]