磁共振引导下激光间质热疗治疗药物难治性癫痫的疗效分析  

Efficacy and safety of magnetic resonance-guided laser interstitial thermal therapy for drug resistant epilepsy

作　　者：胡文瀚[1] 姚远 莫嘉杰 张弨[1] 王秀[1] 刘畅[1] 赵宝田[1] 张建国[1] 张凯[1] HU Wenhan;YAO Yuan;MO Jiajie;ZHANG Chao;WANG Xiu;LIU Chang;ZHAO Baotian;ZHANG Jianguo;ZHANG Kai(Department of Neurosurgery,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)

机构地区：[1]首都医科大学附属北京天坛医院神经外科,北京100070

出　　处：《癫痫杂志》2022年第3期202-206,共5页Journal of Epilepsy

基　　金：国家重点研发计划资助(2021YFC2401201);国家自然科学基金(82071457);首都卫生发展科研专项(2020-2-1076);首都卫生发展科研专项(2022-01-1071)。

摘　　要：目的探究磁共振引导下激光间质热疗(Magnetic resonance-guided laser interstitial thermal therapy,MRgLITT)对药物难治性癫痫患者的治疗效果。方法回顾性分析2020年8月—2021年2月首都医科大学附属北京天坛医院神经外科收治的经MRgLITT的药物难治性癫痫患者的临床资料,包括患者的病变类型、术后并发症及术后1年的Engel分级。结果共纳入55例患者,其中男27例、女28例,平均(21.7±14.1)岁,全部患者均顺利完成手术且均进行了术后1年的随访。纳入包括颅内肿瘤、下丘脑错构瘤、局灶性皮质发育不良、海绵状血管畸形,颞叶癫痫以及行胼胝体切开的患者,术后达到无发作(EngelⅠ)的患者占59.6%(31/52),姑息性手术平均缓解率为68.6%。术后并发症主要包括神经功能缺损6例(10.9%)、出血4例(7.3%,1例为症状性出血)和非感染性发热2例(3.6%),无严重和长期并发症。术后平均住院(4.7±1.6)天,术后恢复快。结论MRgLITT技术逐渐成熟,具有广泛的适应症,对于恰当选择的病例,疗效可与切除性手术接近。该技术为药物难治性癫痫患者提供了一种安全及有效的治疗方式。Objective To analyze the effect of magnetic resonance-guided laser interstitial thermal therapy(Magnetic resonance-guided laser interstitial thermal therapy,MRgLITT)for drug resistant epilepsy(DRE).Methods The present study analyzed the clinical information of DRE patients treated by MRgLITT in Beijing Tiantan Hospital from August 2020 to February 2021,including the type of disease,postoperative complications,and prognosis(Engel classification)in the one year after surgery.Results A total of 55 patients were enrolled.There were 27 males and28 females,with an average of(21.7±14.1)years,all of whom successfully completed the operation and were followed up for the 1 year after surgery.The diagnosis included intracranial tumors,hypothalamic hamartoma(HH),focal cortical dysplasia(FCD),cavernous malformations(CM),mesial temporal lobe epilepsy(mTLE),and idiopathic generalized epilepsy(underwent corpus callosotomy).The patients with seizure freedom accounted for 59.6%(31/52),and the average remission rate of palliative surgery was 68.6%.The short-term postoperative complications included bleeding in neurological deficit in 6 cases(10.9%),4 cases(7.3%),and noninfectious fever in 2 cases(3.6%).No serious,long-term complications occurred.The average postoperative hospital stay was(4.7±1.6)days.Conclusions MRgLITT is gradually mature and has a wide range of indications.This technology provides a safe and effective therapy for DRE patients.

关 键 词：磁共振引导下激光间质热疗 药物难治性癫痫 微创 癫痫外科 

分 类 号：R742.1[医药卫生—神经病学与精神病学]