SEEG引导下手术治疗药物难治性癫痫的安全性及有效性  

Safety and effectiveness of SEEG-guided surgery for patients with drug-resistant epilepsy

作　　者：陈芳卿 徐宏浩 朱海涛[1] 杨露[1] 张焱 张锐[1] CHEN Fang-qing;XU Hong-hao;ZHU Hai-tao;YANG Lu;ZHANG Yan;ZHANG Rui(Department of Functional Neurosurgery,The Brain Hospital Affiliated to Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学附属脑科医院功能神经外科,南京210029

出　　处：《中国临床神经外科杂志》2021年第10期751-754,共4页Chinese Journal of Clinical Neurosurgery

摘　　要：目的探讨立体定向脑电图(SEEG)引导下手术治疗药物难治性癫痫(DRE)的安全性及有效性。方法回顾性分析2018年8月至2020年8月SEEG引导下手术治疗的34例DRE的临床资料。SEEG引导下射频热凝损毁术(RF-TC)治疗28例,RF-TC无效而行致痫区切除术11例,SEEG引导下行致痫区切除术6例。34例术后随访14.0~39.3个月,平均(25.2±7.9)个月。结果28例在SEEG引导下进行RF-TC,术中未出现不适,术后未出现颅内出血,术后4例出现功能障碍;单纯行SEEG引导下RF-TC治疗17例中,癫痫发作完全缓解11例,有效3例,无效3例。11例RF-TC后行致痫区切除术后,3例出现功能障碍,1例出现过敏性休克;术后8例无癫痫发作,2例调整药物后未再出现癫痫发作,1例术后癫痫发作减少60%~70%。6例SEEG引导下直接行致痫区切除术,术后出现功能障碍2例;术后5例无癫痫发作,1例调整抗癫痫药物后未再出现癫痫发作。结论SEEG引导下RTFC治疗DRE是一种相对安全、有效的方法;致痫区广泛或RF-TC无效的DRE病人,可在SEEG引导下行致痫区切除术。Objective To investigate the safety and efficacy of stereoelectroencephalography(SEEG)-guided surgery for the patients with drug-resistant epilepsy(DRE).Methods The clinical data of 34 patients with DRE who underwent SEEG-guided surgery from August 2018 to August 2020 were analyzed retrospectively.Of 34 patients,28 received SEEG-guided radiofrequency thermocoagulation(RF-TC),11 received epileptic zones resection(EZR)due to no effectiveness of RT-FC,and 6 received SEEG-guied EZR.The follow up ranged from 14.0 months to 39.3 months,with an average time of(25.2±7.9)moths.Results Of 28 patients undergoing RF-TC,no discomfort occurred during the operation and no intracranial hemorrhage occurred after the operation,and dysfunction occurred in 4 patients after the operation.Of 17 patients unergoing simple SEEG-guided RF-TC,11 patients had complete seizure relief,3 were effective and 3 were invalid.Of 11 patients undergoing EZR after RF-TC,1 patient suffered from anaphylactic shock during the operation and 3 patients suffered from neurological dysfunction after the operation;8 patients had no epileptic seizures after the operation,2 had no seizures after drug adjustment,and 1 had 60%~70%reduction of postoperative seizures.Of 6 patients undergoing simple SEEG-guided EZR,2 patients suffered from neurological dysfunction after the operation;5 patients had no seizures and 1 had no seizures after drug adjustment.Conclusions SEEG-guided RT-FC is a relatively safe and effective method for the treatment of DRE.For DRE patients with extensive epileptic zones or no effectiveness of RF-TC,SEEG-guided EZR is a good choice.

关 键 词：药物难治性癫痫 立体定向脑电图 射频热凝损毁术 致痫灶切除术 

分 类 号：R742.1[医药卫生—神经病学与精神病学] R651.11[医药卫生—临床医学]