提高难治性癫痫立体脑电图引导射频热凝术后疗效的探讨  

The discussion to improve the curative effect of stereo electroencephalogram-guided radiofrequency thermocoagulation for refractory epilepsy

作　　者：韩彦明[1,3] 沈云娟 何文斌 史哲 兰正波[1,3] 刘亚丽[1,3] 王小强[1,3] 杨文桢[1,3] 史雪峰[1,3] 杨宝慧 王天成[2,3] 门晓旭 张新定[1,3] HAN Yanming;SHEN Yunjuan;HE Wenbin;SHI Zhe;LAN Zhengbo;LIU Yali;WANG Xiaoqiang;YANG Wenzhen;SHI Xuefeng;YANG Baohui;WANG Tiancheng;MEN Xiaoxu;ZHANG Xinding(Department of Neurosurgery,the Second Hospital of Lanzhou University,Lanzhou 730030,China;Department of Neurology,the Second Hospital of Lanzhou University,Lanzhou 730030,China;Comprehensive Epilepsy Center,the Second Hospital of Lanzhou University,Lanzhou 730030,China)

机构地区：[1]兰州大学第二医院神经外科,兰州730030 [2]兰州大学第二医院神经内科,兰州730030 [3]兰州大学第二医院综合癫痫中心,兰州730030

出　　处：《癫痫杂志》2021年第6期505-509,共5页Journal of Epilepsy

基　　金：兰州大学第二医院“萃英科技创新”临床拔尖技术研究(CY2018-BJ12)。

摘　　要：目的初步探讨增加致痫灶内电极数后立体定脑电图(Stereotactic electroencephalography,SEEG)引导射频热凝(Radiofrequency thermocoagulation,RF-TC)毁损效果。方法纳入兰州大学第二医院功能神经外科2017年6月—2019年1月进行癫痫Ⅰ期术前综合评估后需行SEEG的42例患者中的8例,其中6例为假设致痫灶位于功能区或致痫灶位置深在无法手术切除者,2例不愿行开颅手术者;增加假设致痫灶内电极,植入电极数超过定位致痫灶所需电极,射频热凝毁损致痫灶后分析其治疗效果。结果8例患者增加植入电极数1~6根不等,平均(4±2.2)根,增加热凝点2~10个不等,平均(7±3.1)个;随访(9±3.2)个月,癫癫控制情况EngelⅠ级3例,EngelⅡ级3例,EngelⅢ级2例;8例癫痫发作频率均减少≥50%。热凝前后发作频率差异有统计学意义(P<0.05)。结论增加致痫灶的毁损体积明显能提高癫痫疗效,SEEG引导的射频热凝为一种有效的经典切除手术的补充方法。Objective To preliminarily explore the damage effect of stereo electroencephalogram-guided radiofrequency thermocoagulation after increasing the number of electrodes in the epileptic foci.Methods Eight cases were included from 42 patients requiring SEEG from the Department of Neurosurgery of the Second Hospital of Lanzhou University during June 2017 to Jan.2019,of which 6 cases were hypothetical epileptogenic foci located in the functional area or deep in the epileptogenic foci that could not be surgically removed,2 patients who were unwilling to undergo craniotomy;added hypothetical epileptic foci Electrodes,the number of implanted electrodes exceeds the number of electrodes needed to locate the epileptic foci.After radiofrequency thermocoagulation damages the epileptogenic foci,the therapeutic effect is analyzed.Results In 8 patients,the number of implanted electrodes increased from 1~6,with an average of(4±2.2),and the number of thermosetting points increased by 2~10,with an average of(7±3.1);follow-up(9±3.2)months,Epilepsy control status:3 cases of EngelⅠ,3 cases of EngelⅡ,2 cases of EngelⅢ;8 cases of epileptic seizure frequency decreased≥50%.There was a statistically significant difference in the frequency of attacks before and after thermocoagulation(P<0.05).Conclusions Increasing the lesion volume of the epileptic foci can obviously improve the efficacy of epilepsy.SEEG-guided radiofrequency thermocoagulation is an effective supplementary method for classical resection.

关 键 词：立体定向脑电图 射频热凝 疗效 发作频率 

分 类 号：R651.11[医药卫生—外科学]