皮质脑电图联合深部电极监测在局灶性皮质发育不良致难治性癫痫手术中的应用  

Application of electrocorticography and depth electrode electroencephalography in surgery of refractory epilepsy caused by focal cortical dysplasia

作　　者：郭效东 路小奇 王振华 许鹏 刘明辉 郝文明 杨新超 李俊龙 李经纶 王本瀚 Guo Xiaodong;Lu Xiaoqi;Wang Zhenhua;Xu Peng;Liu Minghui;Hao Wenming;Yang Xinchao;Li Junlong;Li Jinglun;Wang Benhan(Department of Neurosurgery,the 988th Hospital of PLA Joint Logistic Support Force,Zhengzhou 450042,China)

机构地区：[1]解放军联勤保障部队第九八八医院全军神经外科中心,郑州450042

出　　处：《中华神经外科杂志》2020年第10期1052-1056,共5页Chinese Journal of Neurosurgery

基　　金：河南省医学科技攻关计划科研项目(LHGJ20190868)。

摘　　要：目的探讨皮质脑电图(ECoG)联合深部电极监测在局灶性皮质发育不良(FCD)Ⅱ型所致难治性癫痫手术中的应用价值。方法回顾性分析2015年3月至2019年3月解放军联勤保障部队第九八八医院神经外科手术治疗15例额叶FCDⅡ型所致难治性癫痫患者的临床资料。术中采用ECoG联合深部电极持续动态监测并定位致痫灶,指导手术切除FCD病灶的范围、深度及周边致痫灶。术后采用Engel分级评估疗效。结果15例患者均顺利完成手术,术中FCD病变处ECoG及深部电极均监测到持续或阵发性尖波、棘波、棘慢复合波;深部电极在FCD周边正常脑组织中亦监测到尖波、棘慢复合波等癫痫样放电,但放电频率较FCD区域减少。依据实时监测结果,采取单纯切除异常病灶5例,切除异常病灶+周围异常放电皮质7例,切除异常病灶+周围异常放电皮质+胼胝体前部切开3例。患者术后情感淡漠、语言不流利、一侧肢体轻偏瘫各3例,均为暂时性并发症,于2个月内恢复。无术后急性癫痫发作的病例。术后MRI显示FCD病灶完全切除12例,部分残留3例。病理学结果:FCDⅡa型6例,FCDⅡb型9例。15例患者的随访时间为(26.5±8.9)个月(14~62个月),Engel分级Ⅰ级10例,Ⅱ级4例,Ⅲ级1例。结论术中采用ECoG联合深部电极持续动态监测能准确定位致痫灶的范围及深度,适合在FCDⅡ型所致难治性癫痫患者手术中应用。Objective To explore the application value of electrocorticography(ECoG)combined with depth electrode electroencephalography(EEG)in surgery of refractory epilepsy caused by focal cortical dysplasia(FCD)type II.Methods A retrospective study was conducted on 15 patients who underwent surgical treatment of refractory epilepsy caused by frontal lobe FCDⅡat Department of Neurosurgery,the 988th Hospital of PLA Joint Logistic Support Force from March 2015 to March 2019.During operation,ECoG and depth electrode were used in combination for continuous monitoring to locate epileptogenic zone(EZ)to guide the range and depth of surgical resection of FCD lesion and surrounding EZ.Engel grade was used to evaluate the efficacy after operation.Results All 15 patients successfully underwent the operation,during which both ECoG and deep electrode EEG at the FCD lesions recorded continuous or paroxysmal sharp waves,spikes and spike-and-wave discharges(SWDs).Deep electrode EEG also recorded epileptiform discharges(EDs)such as sharp waves,spikes and SWDs in normal brain tissue around FCD,while the discharge frequency was lower than that in the FCD region.According to the real-time monitoring results,merely excision of abnormal lesions were undergone in 5 cases,resection of lesion and surrounding tissues with EDs in 7 cases,and resection of lesion and surrounding tissues with EDs plus anterior corpus callosotomy in 3 cases.There was 1 case of postoperative emotional indifference,1 case of disturbed language fluency,and 1 case of light paraplegia,which were all temporary complications and recovered within 2 months.No cases of postoperative acute seizures were reported.Postoperative MRI showed that FCD was completely removed in 12 cases and partial residual was observed in 3 cases.Pathological results showed that there were 6 cases of FCD IIa and 9 cases of FCDⅡb.The follow-up time of 15 patients was 26.5±8.9 months(14 to 62 months).Engel gradeⅠwas reported in 10 cases,gradeⅡin 4 and gradeⅢin 1.Conclusion The combination of i

关 键 词：癫痫 额叶 脑电描记术 深部电极 局灶性皮质发育不良 

分 类 号：R651.1[医药卫生—外科学]