不同影像学表现的药物难治性颞叶癫痫间SEEG电极植入术后疗效比较  

Comparison of efficacies of SEEG electrode implantation in medically-refractory temporal lobe epilepsy with different imaging manifestations

作　　者：张祎鸣 游龙飞 张栋[1] 汪兰兰 刘向 齐印宝 费小瑞 钱若兵 Zhang Yiming;You Longfei;Zhang Dong;Wang Lanlan;Liu Xiang;Qi Yinbao;Fei Xiaorui;Qian Ruobing(Department of Neurosurgery,First Affiliated Hospital of University of Science and Technology of China(Anhui Provincial Hospital),Hefei 230001,China;Department of Neurosurgery,Anhui Second People's Hospital,Hefei 230001,China)

机构地区：[1]中国科学技术大学附属第一医院(安徽省立医院)神经外科,合肥230001 [2]安徽省第二人民医院神经外科,合肥230011

出　　处：《中华神经医学杂志》2023年第5期500-506,共7页Chinese Journal of Neuromedicine

摘　　要：目的探讨术前不同神经影像学表现的药物难治性颞叶癫痫(TLE)患者立体定向脑电图(SEEG)电极植入术后临床疗效的差异。方法选择中国科学技术大学附属第一医院(安徽省立医院)神经外科自2018年1月至2021年12月收治的59例接受SEEG电极植入的药物难治性颞叶癫痫患者为研究对象,按照术前神经影像学评估结果将患者分为MRI阳性组与MRI阴性组、PET-CT阳性组与PET-CT阴性组以及PET-CT与MRI结果一致组(一致组)、PET-CT与MRI结果不一致组(不一致组)。采用改良Engel分级评估患者术后随访12个月时的临床疗效,并比较不同分组患者间临床疗效的差异性。结果MRI阳性组与MRI阴性组间、一致组与不一致组间术后随访12个月时改良Engel分级分布的差异均有统计学意义(P<0.05),其中MRI阳性患者的疗效优于阴性患者(平均秩次分别为27.00、34.08),PET-CT与MRI结果一致患者的疗效优于不一致患者(平均秩次分别为23.32、31.19)。MRI阳性组中不同信号异常区域间术后随访12个月时改良Engel分级分布的差异有统计学意义(P<0.05),其中海马硬化及杏仁核异常患者的疗效优于颞叶内外侧同时异常患者(平均秩次分别为14.50、16.50)。结论当药物难治性颞叶癫痫患者术前MRI阴性尤其是结构性成像与功能性成像结果不一致时,SEEG电极植入及路径规划乃至于后期手术方案都需更加慎重地考虑。Objective To investigate the clinical efficacy differences of stereotactic electroencephalogram(SEEG)electrode implantation in medically-refractory temporal lobe epilepsy(TLE)patients with different neuroimaging manifestations before surgery.Methods A total of 59 patients with medically-refractory TLE who accepted SEEG electrode implantation in Department of Neurosurgery,First Affiliated Hospital of University of Science and Technology of China(Anhui Provincial Hospital)from January 2018 to December 2021 were enrolled.These were divided into groups according to neuroimaging manifestations before surgery,including MRI-positive group and MRI-negative group,PET-positive group and PET-negative group,or PET&MRI concordant group(concordant group)and PET&MRI discordant group(discordant group).Modified Engel classification was used to evaluate the clinical efficacy of these patients at 12-month follow-up after surgery,and efficacy differences among different patient groups were compared.Results Significant differences were noted in distributions of modified Engel classification between the MRI positive and negative groups,as well as the concordant and discordant groups at 12-month follow-up after surgery(P<0.05);patients in the MRI positive group had better outcomes than those in the MRI negative group(mean rank judgment:27.00 and 34.08),while patients in concordant group had better outcomes than those in discordant group(mean rank judgment:23.32 and 31.19).Significant differences were noted in distributions of modified Engel classification at 12-month follow-up after surgery between different signal abnormal regions in the MRI positive group(P<0.05);patients with hippocampal sclerosis or amygdala abnormalities had better outcomes than those with simultaneous abnormalities in the temporal lobe internal and external regions(mean rank judgment:14.50 and 16.50).Conclusion When the preoperative MRI of patients with medically-refractory TLE is negative,especially when results of structural imaging and functional imaging are i

关 键 词：神经影像学 立体定向脑电图 药物难治性癫痫 颞叶癫痫 

分 类 号：R742.1[医药卫生—神经病学与精神病学]