立体定向脑电图证实的岛叶癫痫手术疗效分析  

Analysis of surgical effect on insular epilepsy confirmed by stereoelectroencephalography

作　　者：孙亚媚 龚德山 尚丽 吴德深 沈衍超 郭辉[1] SUN Ya-mei;GONG De-shan;SHANG Li;WU De-shen;SHEN Yan-chao;GUO Hui(Department of Neurosurgery,Shanghai Deji Hospital-the 9th Clinical College,Qingdao University,Shanghai 200331,China;Department of Epilepsy,Shanghai Deji Hospital-the 9th Clinical College,Qingdao University,Shanghai 200331,China)

机构地区：[1]上海德济医院-青岛大学第九临床医学院神经外科,上海200331 [2]上海德济医院-青岛大学第九临床医学院癫痫内科,上海200331

出　　处：《复旦学报（医学版）》2022年第1期100-106,共7页Fudan University Journal of Medical Sciences

摘　　要：目的探讨经立体定向脑电图(stereoelectroencephalography,SEEG)证实为岛叶起源的难治性癫痫的手术疗效。方法选取2017年4月至2020年10月上海德济医院癫痫中心行SEEG监测明确为岛叶起源的难治性癫痫病例11例,回顾性分析其临床资料(症状学、头皮脑电图、影像学、SEEG结果、术后病理学诊断以及术后癫痫控制情况等),评估并探讨岛叶起源的难治性癫痫的外科手术疗效。结果11例患者共植入电极148根,其中岛叶电极69根,未出现电极相关并发症。所有患者均按照个体化手术方案行致痫灶切除,随访时间6~42个月。术后9例患者无癫痫发作(EngelⅠ级),1例仅有轻型发作(EngelⅡ级),1例仍有癫痫频繁发作(EngelⅣ级)。组织病理学诊断:神经胶质增生6例,灶性软化3例,结节性硬化1例,炎症1例(脑膜炎病史)。术后2例患者出现不同程度的对侧肢体偏瘫,1例患者出现混合性失语,1例剧烈呕吐,1例颅内感染。上述除1例患者出现永久性一侧肢体轻瘫外,其余病例均于1个月内恢复正常。结论经SEEG监测明确为岛叶起源的难治性癫痫经临床评估后可行外科手术切除治疗者,多能够获得较为满意的癫痫控制结果。Objective To investigate the surgical effect of intractable epilepsy originating from insular lobe confirmed by stereoelectroencephalography(SEEG).Methods Eleven patients with refractory epilepsy diagnosed insular epilepsy were monitored by SEEG in the Epilepsy Center of Shanghai Deji Hospital from Apr 2017 to Oct 2020.Their clinical data(symptomatology,scalp EEG,neuroimaging,SEEG results,pathological diagnosis and surgical outcomes,etc.)were analyzed retrospectively to evaluate and explore the surgical effect on refractory epilepsy originating from insular lobe.Results A total of 148 electrodes were implanted without any electrode-related complications,including 69 electrodes implanted within insular lobe.All patients accepted surgery according to respective resection plan,and the follow-up period was 6-42 months.Nine patients had no seizures(Engel gradeⅠ),1 case had only mild seizures(Engel gradeⅡ),and 1 case still had frequent seizures(Engel gradeⅣ).Histopathological diagnosis includes 6 cases of glial hyperplasia,3 cases of focal encephalomalacia,1 case of tuberous sclerosis and 1 case of inflammation(the patients who had meningitis history).After operation,two patients suffered contralateral hemiplegia,one patient had mixed aphasia,one patient suffered severe vomiting and one patient had intracranial infection.All of them recovered within 1 month except one patient with long-term unilateral limb paresis.Conclusion The intractable epilepsy originating from insular lobe which is confirmed by SEEG can be treated by surgery safely,and satisfactory results of epilepsy control can be obtained.

关 键 词：岛叶癫痫 难治性癫痫 立体定向脑电图(SEEG) 

分 类 号：R742.1[医药卫生—神经病学与精神病学]