皮质脑电图联合深部电极监测在症状性癫痫手术中的应用及疗效影响因素分析  

Application of electrocorticography combined with deep electrode monitoring in sur⁃gery for symptomatic epilepsy and influencing factors for treatment outcome

作　　者：梁明礼[1] 叶敏[1] 张文波[1] 杨玉先[1] 刘文浩[1] LIANG Ming-Li;YE Min;ZHANG Wen-Bo;YANG Yu-Xian;LIU Wen-Hao(Department of Neurosurgery,people's Hospital of Meizhou City,Guangdong Province,Meizhou,Guangdong 514031,China)

机构地区：[1]梅州市人民医院神经外一科,广东梅州514031

出　　处：《国际神经病学神经外科学杂志》2021年第6期530-533,共4页Journal of International Neurology and Neurosurgery

基　　金：广东省医学科研基金项目(A2018697)。

摘　　要：目的探讨皮质脑电图(ECoG)联合深部电极监测在症状性癫痫手术中的应用及疗效影响因素分析。方法回顾性分析2017年1月—2020年6月该院收治的24例行症状性癫痫手术患者的临床资料。术中采用ECoG联合深部电极监测并定位致痫灶,确定手术切除病灶深度、范围及周围致痫灶。术后随访12个月,采用Engel分级评估疗效,并根据疗效分为有效组(18例)、无效组(6例)。采用单因素分析、多因素Logistic回归分析症状性癫痫手术疗效的影响因素。结果所有患者均顺利完成手术,术中ECoG、深部电极均监测到病变处阵发性或持续性棘慢复合波、棘波、尖波;此外,深部电极还在病变周围正常脑组织内监测到明显棘慢复合波、尖波,但放电程度及频率均较病变部位低。术后出现暂时性单侧肢体轻度偏瘫、语言障碍、情感淡漠各2例,术后2个月恢复正常,术后无严重感染及颅内出血等发生。多因素Logistic回归分析结果显示,病程>2年[OR:6.500,95%CI:1.741~24.274]、部分切除致痫灶[OR:14.583,95%CI:1.545~137.661]为症状性癫痫手术疗效的危险因素,而术后无早期发作[OR:0.066,95%CI:0.012~0.368]为症状性癫痫手术疗效的保护因素。结论症状性癫痫手术中采用ECoG联合深部电极监测可精准定位致痫灶深度及范围。患者病程、致痫灶切除程度、术后早期癫痫发作情况等为症状性癫痫手术疗效影响因素。Objective To investigate the application of electrocorticography(ECoG)combined with deep electrode monitoring in surgery for symptomatic epilepsy and the influencing factors for treatment outcome.Methods A retrospective analysis was performed for the clinical data of 53 patients who were admitted to our hospital from January 2017 to December2019 and underwent the surgery for symptomatic epilepsy. During the surgery,ECoG and deep electrodes were used to monitor and locate epileptogenic foci and determine the depth and extent of epileptic foci and surrounding epileptogenic foci for surgical resection. The patients were followed up for 12 months after surgery,and Engel classification was used to evaluate treatment outcome. The patients were divided into response group with 36 patients and non-response group with 17 patients according to the treatment outcome. Univariate and multivariate logistic regression analyses were used to investigate the influencing factors for the surgical outcome of symptomatic epilepsy.Results All patients completed the surgery successfully.During the surgery,both ECoG and deep electrodes detected paroxysmal or persistent spike and slow wave complex,spike waves,and sharp waves at focal cortical dysplasia(FCD)lesion,and in addition,deep electrodes detected spike and slow wave complex and sharp waves in normal brain tissue around FCD lesion,which had lower discharge degree and frequency than the waves detected in FCD lesion. After surgery,there were 2 patients with temporary mild hemiplegia of unilateral limb,2 patients with language disorder,and 2 patients with apathy,which returned to normal at 2 months after surgery,and no serious infection or intracranial hemorrhage occurred after surgery. The multivariate logistic regression analysis showed that course of disease >2 years(odds ratio[OR]= 6.500,95% confidence interval[CI]:1.741-24.274)and partial resection of epileptogenic foci(OR = 14.583,95% CI:1.545-137.661)were risk factors for the surgical outcome of symptomatic epilepsy,and no early

关 键 词：症状性癫痫 皮质脑电图 深部电极监测 手术疗效 影响因素 

分 类 号：R742.1[医药卫生—神经病学与精神病学]