立体脑电图引导下射频热凝术在局灶性癫痫患者中的应用价值  

Stereo-electroencephalography-guided radiofrequency thermocoagulation in treatment of focal epilepsy

作　　者：王乐[1] 金卫篷[2] 王世民[3] 李清云[3] 秦洁[3] 张艳[1] 尹绍雅[2] Wang Le;Jin Weipeng;Wang Shimin;Li Qingyun;Qin Jie;Zhang Yan;Yin Shaoya(Clinical College of Neurology,Neurosurgery and Neurorehabilitation,Tianjin Medical University,Tianjin 300350,China;Department of Functional Neurosurgery,Huanhu Hospital of Tianjin,Tianjin 300350,China;Department of Neurology,Huanhu Hospital of Tianjin,Tianjin 300350,China)

机构地区：[1]天津医科大学神经内外科及神经康复临床学院,天津300350 [2]天津市环湖医院功能神经外科,300350 [3]天津市环湖医院神经内科,300350

出　　处：《中华神经医学杂志》2021年第11期1142-1148,共7页Chinese Journal of Neuromedicine

基　　金：天津市自然科学基金面上项目(20JCYBJC00930、20JCYBJC00920)。

摘　　要：目的:探讨立体脑电图(SEEG)引导下射频热凝术(RFTC)在局灶性癫痫患者中的应用价值。方法:选择天津市环湖医院功能神经外科自2019年4月至2020年12月在SEEG引导下RFTC治疗的18例局灶性癫痫患者,回顾性分析患者的临床资料,通过门诊复诊或电话进行随访,采用Engel分级评估患者的疗效。结果:(1)18例患者分别植入电极4~11根,平均(6.56±2.15)根;其中单侧植入6例,双侧植入12例,均准确植入预期靶点。SEEG监测显示额叶癫痫7例,颞叶癫痫8例,额颞交界区癫痫2例,颞枕交界区癫痫1例。(2)18例患者分别热凝电极2~9根,平均(3.43±1.47)根;热凝触点数9~42个,平均(17.38±9.20)个。热凝过程中诱发癫痫发作1例,热凝后发生暂时性精神症状1例,伴颅内压增高症状的脑区弥漫性水肿1例,无症状区域性脑水肿1例。并发症的总体发生率为22.2%(4/18),无永久性神经功能损害发生。(3)11例患者在RFTC治疗后癫痫复发,其中在热凝后1个月内复发3例,在热凝后1~3个月内复发3例,在热凝后3~6个月内复发3例,在热凝后6~12个月内复发2例,复发患者的发作持续时间和频率均较RFTC前明显降低。7例患者在RFTC后进一步接受开颅致痫灶切除术。患者随访5~24个月,末次随访时疗效:Engel分级Ⅰ级12例、Ⅱ级4例、Ⅲ级2例,无Ⅳ级患者。结论:SEEG引导下RFTC治疗可使局灶性癫痫患者获得不同时限的癫痫发作完全缓解期,部分患者可达到癫痫发作的长期缓解。对SEEG引导下RFTC治疗后癫痫复发者,进一步行开颅致痫灶切除术仍可获良好疗效。Objective To investigate the value of stereo-electroencephalography(SEEG)-guided radiofrequency thermocoagulation(RFTC)in patients with focal epilepsy.Methods Eighteen patients with focal epilepsy admitted to and treated by SEEG-guided RFTC in our hospital from April 2019 to December 2020 were chosen.The clinical data of these patients were retrospectively analyzed,and follow up was performed monthly by telephone and outpatient subsequent visit.The treatment efficacies of these patients were evaluated by Engel grading.Results(1)The number of electrodes accurately implanted into the intended target in these 18 patients was 4-11(6.56±2.15 on average);unilateral implantation was noted in 6 patients,and bilateral implantation was noted in 12 patients.SEEG monitoring showed that 7 patients were with frontal lobe epilepsy,8 were with temporal lobe epilepsy,2 were with frontotemporal junction epilepsy,and one was with temporal occipital junction epilepsy.(2)Two-9 RFTC electrodes(3.43±1.47 on average),and 9-42 RFTC contacts(17.38±9.20 on average)were given in these 18 patients.One patient developed seizures during the course of RFTC,one had temporary mental symptoms after RFTC,one had diffuse brain edema with intracranial hypertension,and one had asymptomatic regional brain edema.The total complication incidence was 22.2%(4/18)and no permanent neurological impairment occurred.(3)Eleven patients(61.1%)had recurred seizure within 1 year of RFTC:3(27.3%)recurred within 1 month,3(27.3%)recurred within 1-3 months,3(27.3%)recurred within 3-6 months,and 2(18.2%)recurred within 6-12 months;however,the duration and frequency of seizure were obviously decreased as compared with those before RFTC.Seven patients(38.9%)received craniotomy after RFTC;follow up for 5-24 months showed that 12 patients were with Engel grading I,4 were with Engel grading II,2 were with Engel III,and no one was with Engel grading IV.Conclusions SEEG-guided RFTC has enabled patients with focal epilepsy to achieve complete remission of their seizures with

关 键 词：局灶性癫痫 立体脑电图 射频热凝术 微创手术 

分 类 号：R651.11[医药卫生—外科学]