立体脑电图引导射频热凝毁损治疗下丘脑错构瘤相关癫痫的长期疗效观察  

Long-term efficacy of stereo-electroencephalography-guided radiofrequency thermocoagulation in hypothalamic hamartoma related epilepsy

作　　者：刘畅[1] 张凯[1] 郑重[2] 周峰[2] 解飞[2] 李冬智 杨晓丽 高冬梅 马延山[2] 桑林[2] Liu Chang;Zhang Kai;Zheng Zhong;Zhou Feng;Xie Fei;Li Dongzhi;Yang Xiaoli;Gao Dongmei;Ma Yanshan;Sang Lin(Department of Neurosurgery,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;Department of Neurosurgery,Beijing Fengtai Hospital,Beijing 100071,China)

机构地区：[1]首都医科大学附属北京天坛医院神经外科,100070 [2]北京丰台医院神经外科,100071

出　　处：《中华神经外科杂志》2021年第8期771-775,共5页Chinese Journal of Neurosurgery

基　　金：国家重点研发计划(2018YFC00115401);国家自然科学基金(82071457,81771399);首都卫生发展科研专项(2020-2-1076)。

摘　　要：目的探讨立体脑电图(SEEG)引导射频热凝毁损技术在下丘脑错构瘤相关癫痫治疗中的长期有效性和安全性。方法回顾性分析2015年6月至2018年11月北京丰台医院神经外科—首都医科大学附属北京天坛医院医疗联盟收治的15例下丘脑错构瘤相关癫痫患者的临床资料。所有患者均接受SEEG电极置入并进行视频脑电监测。根据SEEG结果和影像后处理结果确定毁损触点,利用电极触点进行热凝毁损。分别于术后3、9及24个月对患者进行门诊复查或电话随访。采用Engel分级标准评估临床疗效,同时观察记录远期并发症情况。结果仅1例患者进行2次SEEG引导下射频热凝毁损,15例患者共完成16次电极置入。术后11例患者癫痫发作消失。6例患者出现不同程度的并发症,其中中枢性发热、尿崩、电解质紊乱及嗜睡均在出院时缓解,Horner综合征和肌力下降等症状在首次随访时已缓解。15例患者均完成2年以上随访,随访时间为(39.6±13.0)个月(25~66个月)。3个月随访时所有患者的头颅MRI复查结果均显示瘤蒂被不同程度毁损,脑电图结果显示异常放电消失。至末次随访,15例患者中,11例癫痫发作完全消失(EngelⅠa级),2例明显改善(EngelⅠb~Ⅲ级),2例未见明显改善(EngelⅣ级)。2例患者出现长期并发症,包括体重增加、记忆力减退及内分泌紊乱。结论长期随访证实,SEEG引导射频热凝毁损术治疗下丘脑错构瘤相关癫痫的安全性和有效性均较好。Objective To investigate the long-term efficacy and safety of stereo-electroen-cephalography(SEEG)-guided radiofrequency thermocoagulation(RFTC)in hypothalamic hamartoma related epilepsy.Methods The clinical data of 15 patients with hypothalamic hamartoma related epilepsy admitted to the Department of Neurosurgery of Beijing Fengtai Hospital,Medical Alliance of Beijing Tiantan Hospital,Capital Medical University from June 2015 to November 2018 were retrospectively analyzed.All patients underwent SEEG electrode placement and video-EEG monitoring.According to the SEEG results and the image post-processing results,the contacts for RFTC lesioning were determined,and the electrode contacts were used for thermal coagulation.The patients were re-examined at clinics or followed up by telephone at 3,9 and 24 months after surgery.The Engel grading standard was used to evaluate the clinical efficacy,while the long-term complications were observed and documented.Results Only 1 patient underwent 2 times of SEEG-guided RFTC,15 patients completed a total of 16 electrode placements.The seizures disappeared in 11 patients after operation.Six patients had complications of varying degrees.Among them,central fever,diabetes insipidus,electrolyte imbalance and drowsiness were relieved upon discharge.Horner syndrome and decreased muscle strength were relieved at the first follow-up.All 15 patients completed the follow-up for more than 2 years,and the follow-up time was 39.6±13.0 months(25-66 months).At the 3-month follow-up,the results of head MRI re-examination of all patients showed that the tumor pedicle was lesioned to varying degrees,and the EEG results showed that the abnormal discharge disappeared.At the last follow-up,11 of the 15 patients reported seizure free(EngelⅠa),2 cases were significantly improved(EngelⅠb-Ⅲ),and 2 cases had no significant improvement(EngelⅣ).Two patients had long-term complications,including weight gain,memory loss,and endocrine disorders.Conclusion Long-term follow-up has confirmed that SEEG-g

关 键 词：癫痫 治疗结果 立体脑电图 热凝毁损 下丘脑错构瘤 

分 类 号：R742.1[医药卫生—神经病学与精神病学]