立体定向脑电图引导下立体交叉射频热凝毁损治疗药物难治性岛叶癫痫的安全性及有效性观察  

Observation of efficacy and safety of stereotactic-EEG-guided three-dimensional radiofrequency thermocoagulation for the treatment of drug-resistant insular epilepsy

作　　者：戴阳 王逸鹤[1] 安阳[1] 卢超[1] 张华强 樊晓彤[1] 魏鹏虎 任连坤 单永治[1] 赵国光[1] Dai Yang;Wang Yihe;An Yang;Lu Chao;Zhang Huaqiang;Fan Xiaotong;Wei Penghu;Ren Liankun;Shan Yongzhi;Zhao Guoguang(Department of Neurosurgery,Xuanwu Hospital,Clinical Research Center for Epilepsy,Capital Medical University,Beijing 100053,China;Department of Neurology,Xuanwu Hospital,Clinical Research Center for Epilepsy,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院神经外科,首都医科大学癫痫临床诊疗与研究中心,北京100053 [2]首都医科大学宣武医院神经内科,首都医科大学癫痫临床诊疗与研究中心,北京100053

出　　处：《中华医学杂志》2021年第41期3386-3392,共7页National Medical Journal of China

基　　金：国家自然科学基金(82030037,81871009,81801288);北京市科学技术委员会(Z161100000516008);北京市医管局青苗计划(QML20190805)。

摘　　要：目的观察立体定向脑电图(SEEG)引导下多电极立体交叉射频热凝毁损(RF-TC)治疗药物难治性岛叶癫痫的安全性及有效性。方法回顾性纳入首都医科大学宣武医院神经外科2017年2月至2019年6月采用SEEG引导下立体交叉RF-TC治疗的7例药物难治性岛叶癫痫患者。依据症状学、头皮脑电图及影像学资料等术前评估考虑致痫灶位于岛叶,根据评估结果设计岛叶电极行立体交叉RF-TC治疗。术后通过门诊或电话进行随访,采用Engel分级进行预后评估,并观察手术相关并发症。结果7例患者在术后18个月进行随访,截止至末次随访,4例患者术后癫痫发作消失(EngelⅠA级),2例患者术后稀少简单部分发作(EngelⅠB级),1例患者术后癫痫发作频率减少75%(EngelⅢA级)。术后3例患者出现一过性右侧下肢感觉减退,右侧上肢肌力减退、言语不清及记忆力减退,理解力下降,无永久性神经功能障碍。结论SEEG引导的立体交叉RF-TC治疗是对药物难治性岛叶癫痫患者安全、有效的治疗手段。该技术可作为开放性致痫区切除手术的一种补充治疗方法。Objective To investigate the safety and efficacy of stereotactic-EEG(SEEG)-guided radiofrequency thermocoagulation(RF-TC)with three-dimensional lesioning in the treatment of drug-resistant insular epilepsy.Methods Seven patients with drug-resistant insular epilepsy who underwent SEEG-guided RF-TC with three-dimensional ablation at the Department of Neurosurgery of Xuanwu Hospital,Capital Medical University from February 2017 to June 2019 were retrospectively enrolled.Presurgical evaluation including semiology,EEG and imaging results suggested that the epileptogenic zone was located in the insular lobe.All patients underwent SEEG recording and three-dimensional RF-TC.Postoperative follow-up was conducted by outpatient visits or telephone,the clinical efficacy was evaluated based on Engel classification and the relevant complications were documented.Results Seven patients were followed up at 18 months after surgery.Among them,4 were seizure free(EngelⅠA),2 had nondisabling simple partial seizures(EngelⅠB)and 1 achieved 75%decrease(EngelⅢA)in seizure frequency.Postoperative complications occurred in 3 patients which included decreased sensation in the right lower extremity,decreased strength in the right upper extremity,glossolalia,decline in memory and comprehension.No permanent neurological dysfunction was detected.Conclusion SEEG-guided RF-TC with three-dimensional lesioning is minimally invasive,safe and effective in the treatment of drug-resistant insular epilepsy and can serve as a complementary method for resection surgery.

关 键 词：癫痫 岛叶 立体定向脑电图 三维 射频热凝 

分 类 号：R742.1[医药卫生—神经病学与精神病学]