立体脑电图引导下射频热凝消融术治疗围生期脑损伤后癫痫的初步疗效观察  

Primary observation of clinical efficacy of radiofrequency thermocoagulation guided by stereotactic electroencephalography for the treatment of epilepsy due to perinatal brain injury

作　　者：张冰清[1] 王海祥[1] 丰倩[1] 贺晶[1] 林久銮[1] 柏建军[1] 周文静[1] Zhang Bingqing;Wang Haixiang;Feng Qian;He Jing;Lin Jiuluan;Bai Jianjun;Zhou Wenjing(Department of Neurosurgery,Tsinghua University Yuquan Hospital,Beijing 100040,China)

机构地区：[1]清华大学玉泉医院(清华大学中西医结合医院)神经外科,北京100040

出　　处：《中华神经外科杂志》2023年第8期799-803,共5页Chinese Journal of Neurosurgery

摘　　要：目的初步观察立体脑电图(SEEG)引导下多触点射频热凝消融术(RF-TC)治疗围生期脑损伤后癫痫患儿的可行性及其临床疗效。方法回顾性分析2014年1月至2021年6月清华大学玉泉医院(清华大学中西医结合医院)神经外科采用SEEG引导下多触点RF-TC治疗的7例难治性围生期脑损伤后癫痫患儿的临床资料。头颅MRI显示双侧病变6例,右侧顶叶局灶性损伤1例。所有患儿发作间歇期头颅正电子发射断层显像-CT检查均显示双侧后头部葡萄糖摄取明显减低。所有患儿行SEEC电极植入,行SEEG引导下多触点RF-TC。RF-TC术后3个月、6个月、1年门诊复查脑电图和头颅MRI。采用Engel分级标准进行疗效评估。结果7例患儿RF-TC过程均顺利,其中进行1次RF-TC2例,2次3例3次2例。1例患儿热凝过程中出现一过性视觉先兆并于热凝结束后消失。7例患儿热凝过程及热凝后均未发生手术并发症。7例患儿的随访时间为18~52个月。2例术后无癫痫发作,2例癫痫发作减少或减轻,1例术后癫痫无改善,2例复发(分别于术后6、12个月)。1例癫痫发作减轻患儿于术后6个月行左侧顶盖激光消融手术。1例因术后6个月癫痫复发行右侧顶叶局灶性切除术,术后无发作。至末次随访,Engel分级Ⅰ级4例,Ⅲ级2例,Ⅳ级1例。结论初步观察显示,SEEG引导下多触点RF-TC治疗围生期脑损伤后癫痫患儿可行、安全性较好,术后可一定程度改善癫痫发作,但可观察到部分患儿癫痫复发。Objective To preliminarily observe the feasibility and clinical efficacy of stereoelectroencephalography(SEEG)-guided multi-contact radiofrequency thermocoagulation(RF-TC)in the treatment of epilepsy due to perinatal brain injury.Methods A retrospective analysis was conducted on the clinical data of 7 patients with intractable epilepsy due to perinatal brain injury who underwent SEEGguided multi-contact RF-TC at the Department of Neurosurgery,Tsinghua University Yuquan Hospital from January 2014 to June 2021.The MRI scan of 6 patients showed bilateral lesions and 1 patient showed right parietal lobe lesion.Positron emission tomography(PET)-CT showed significant decrease of glucose uptake in bilateral posterior cortices during the interictal period of all patients.All patients underwent implantation of SEEG and SEEG-guided multi-contact RF-TC.All patients were reviewed 3 months,6 months,and 1 year after RF-TC.The follow-up content included EEG and MRI.The outcome was evaluated based on the Engel grading system.Results The RF-TC process of 7 patients was all smooth,among which 2 cases underwent 1 procedure of RF-TC,3 cases underwent 2 procedures(times)of RF-TC,and 2 cases underwent 3 procedures RF-TC.One patient had a transient visual aura during the thermocoagulation process which disappeared after the thermocoagulation ended.No surgical complications occurred in the 7 patients during or after thermocoagulation.The follow-up time of 7 patients ranged from 18 to 52 months.Two cases were seizure free after operation,2 cases had reduced or alleviated seizures,1 case had no improvement after operation,and 2 cases had recurrence(6 and 12 months after operation respectively).One patient with reduced seizures underwent laser ablation of the left tectum 6 months after the operation.One case underwent focal resection of the right parietal lobe due to seizure recurrence 6 months after the operation,and there was no seizure after the operation.At the last follow-up,there were 4 cases of Engel grade I,2 cases of grade Ⅲ,and

关 键 词：癫痫 围产期脑损伤 立体脑电图 射频热凝消融 

分 类 号：R742.1[医药卫生—神经病学与精神病学]