基于框架的立体定向脑电图在癫痫灶定位中的应用  

Application of intracranial electrode implantation using stereotactic frame in identification of epileptogenic zone

作　　者：解飞[1] 胡文瀚[2] 桑林[1] 马延山[1] 张弨[3] 张凯[3] 邵晓秋[4] 张建国[3] Xie Fei;Hu Wenhan;Sang Lin;Ma Yanshan;Zhang Chao;Zhang Kai;Shao Xiaoqiu;Zhang Jianguo(Epilepsy Center,Belling Fengtai Hospital,Medical Alliance of Beifing Tiantan Hospital,Capital Medical University,Beijing 100071,China)

机构地区：[1]北京丰台医院癫痫中心-首都医科大学附属北京天坛医院医疗联盟,100071 [2]首都医科大学、北京市神经外科研究所 [3]首都医科大学附属北京天坛医院神经外科 [4]首都医科大学附属北京天坛医院神经病学中心癫痫科

出　　处：《中华神经外科杂志》2018年第9期921-925,共5页Chinese Journal of Neurosurgery

基　　金：首都卫生发展科研专项（2016-1-1071）;首都医科大学基础-临床科研合作课题（17JL05）

摘　　要：目的探讨基于框架的立体定向脑电图（SEEG）定位致痫灶的安全性及可靠性。方法回顾性纳入北京丰台医院癫痫中心-首都医科大学附属北京天坛医院医疗联盟2015年6月至2016年6月收治的采用SEEG评估的药物难治性癫痫患者，共60例。分析影响SEEG电极植入靶点偏差的相关指标、电极植入相关的并发症。电极植人术后行长程视频脑电图监测，根据评估结果行手术切除致痫灶，观察手术预后。结果60例患者共植入颅内电极474根，每例患者平均植入电极（8．0±2．5）根；电极植入的入针点偏差为0．0～8．3mm，中位数为1．1mm；靶点偏差0～12mm，中位数为1．4mm；电极与颅骨切面夹角为44．0—90．0°，中位数为67．5°；电极在脑内的长度为15～97mm，中位数为43mm。相关性分析显示，靶点偏差与人针点偏差（r=0．426，P〈0．01）、电极植入长度（r=0．145，P〈0．01）均呈正相关；与电极与颅骨切面夹角呈负相关（r=-0．247，P〈0．01）。共6例（10％）发生电极植入术相关的并发症，其中脑内少量血肿3例（5％），脑脓肿1例（2％），电极弯折2例（3％）。53例患者行致痫灶切除手术，术后随访1—2年，平均（1．5±0．5）年，其中EngelⅠ级者占72％（38／53），EngelⅡ-Ⅳ级者占28％（15／53）。EngelⅠ级者中，MRI阳性者占74％（20／27），阴性者占69％（18／26）。结论基于框架的SEEG颅内电极植入技术安全可靠，结合术后视频脑电图可以很好地应用于致痫灶的定位。Objective To explore the safety and reliability of intracranial electrode implantation based on stereotactic frame. Methods Sixty patients with refractory epilepsy were retrospectively included from June 2015 to June 2016 in Beijing Tiantan-Fengtai Epilepsy Center. We analyzed relevant indexes which might influence the SEEG （stereo-electroencephalograhy） electrode implantation target deviations and complications related to the implantation. Video-EEG monitoring was conducted after the electrode implantation before operation was performed to remove the seizure focus according to the preoperative evaluation. Outcomes were followed-up. Results Sixty patients underwent a total of 474 intracranial electrodes implantation with an average electrode number of 8.0 ± 2.5 and an average application time of 13.5 ± 3.1 min per electrode. The entrance point deviation, target deviation, electrode-skull angle and electrode length in the brain were0.0-8.3 mm （median： 1.1 mm）, 0-12 mm （median： 1.4 mm）, 44.0 - 90.0° （ median ： 67.5 ° ） and 15 - 97 mm（ median ： 43 mm）, respectively. The target deviation was positively correlated with the deviation of entry point （ r = 0. 426, P 〈 0.01 ）. The target deviation was negatively correlated with the electrode skull angle （r = -0. 247, P 〈 0.01 ）. The target deviation was positively correlated with the length of electrode in the brain （ r = 0. 145, P 〈 0.01 ）. There are totally 6 （ 10% ） cases developing complications including small amount of cerebral hematoma in 3 （5%）, brain abscess in 1（2% ） and electrode bending in 2（3% ）. Fifty-three patients were followed up for 1 -2 （ 1.5 ±0.5） years post resection surgery. There was 72% （38/53） of the patients achieving seizure free （ Engel Ⅰ）. Meanwhile, seizures remained in the other 28% （15/53） of the patients （Engel Ⅱ- Ⅳ）. Conclusion Thestereotactic frame- based intracranial electrode implantation technique seems safe and reliable. Combined with postope

关 键 词：癫痫 神经外科手术 立体定向脑电图 预后 

分 类 号：R742.1[医药卫生—神经病学与精神病学]