MRI引导下激光间质热疗术治疗脑深部致痫灶所致药物难治性癫痫的临床效果分析  

Analysis of the clinical efficacy of MRI-guided laser interstitial thermal therapy in the treatment of epilepsy caused by epileptogenic lesions in deep brain

作　　者：王秀[1] 胡文瀚[2] 张弨[1] 莫嘉杰 邵晓秋[3] 张建国[1,2] 张凯[1] Wang Xiu;Hu Wenhan;Zhang Chao;Mo Jiajie;Shao Xiaoqiu;Zhang Jianguo;Zhang Kai(Neurosurgery Center,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;Beijing Neurosurgical Institute,Capital Medical University,Beijing 100070,China;Department of Neurology,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学中心,北京100070 [2]首都医科大学,北京市神经外科研究所,北京100070 [3]首都医科大学附属北京天坛医院神经内科,北京100070

出　　处：《中华神经外科杂志》2024年第2期113-118,共6页Chinese Journal of Neurosurgery

基　　金：国家自然科学基金(82201603,82071457,82271495,82201600)。

摘　　要：目的 探讨MRI引导下的激光间质热疗术(MRgLITT)毁损药物难治性癫痫患者脑深部致痫灶的手术方法和临床疗效.方法 回顾性分析2020年8月至2022年12月于首都医科大学附属北京天坛医院神经外科学中心接受MRgLITT治疗、且致痫灶位于侧裂深部或中线旁的药物难治性癫痫患者的临床资料.患者术前接受多学科评估并定位致痫灶,根据评估结果进行手术方案的设计.术后采用门诊或视频电话随访,评估患者的术后癫痫无发作率(比例)和并发症情况.结果 共纳入15例药物难治性癫痫患者.致痫灶位于岛叶岛盖部4例,中线旁11例.岛叶病变多采用经额或经顶入路、平行于岛叶沟回方向进行穿刺,中线区致痫灶多采用经额或经顶近平行于中线进行光纤置入.病变性质为局灶性皮质发育不良者以毁损沟底为主要目的.MRgLITT的成功比例为15/15.所有患者均获得随访,随访时间为(18.2±5.4)个月(12~36个月).至末次随访,癫痫无发作比例为11/15,仅1例遗留轻度足部背屈障碍.结论 对致痫灶位于脑深部的药物难治性癫痫患者,采用MRgLITT可精准定位致痫灶并明确毁损范围,从而获得较为理想的手术疗效,其并发症少且轻微.ObjectiveTo explore the surgical method and clinical efficacy of MRI-guided laser interstitial thermal therapy(MRgLITT)to destroy epileptogenic lesions in the deep brain.MethodsA retrospective analysis was conducted on the clinical data of patients with drug-refractory epilepsy who received MRgLITT at the Neurosurgery Center,Beijing Tiantan Hospital,Capital Medical University from August 2020 to December 2022.In those patients,the epileptogenic zone was located deep in the Sylvian fissure or next to the midline.Patients underwent preoperative multidisciplinary assessment to locate the epileptogenic zone,and a surgical plan was designed based on the assessment results.Postoperative outpatient or video phone follow-up was used to evaluate the patient′s postoperative seizure free rate and complications.ResultsA total of 15 patients with drug-refractory epilepsy were included.The epileptogenic zone was located in the insula in 4 cases and next to the midline area in 11 cases.For insular lesions,transfrontal or transparietal approaches were often used to puncture parallel to the direction of the insular sulcus.Epileptogenic lesions in the midline area were often punctured via transfrontal or transparietal approaches,nearly parallel to the midline.In cases of focal cortical dysplasia,the main purpose was to ablate the bottom of the sulcus.The success rate of MRgLITT was 15/15.All patients were followed up,and the follow-up time was 18.2±5.4 months(12 to 36 months).By the last follow-up visit,the seizure free rate was 11/15,and only 1 case had long-term foot dorsiflexion disorder.ConclusionFor patients with drug-refractory epilepsy whose epileptogenic zone was located deep in the brain,MRgLITT can help accurately locate the epileptogenic zone and clarify the scope of ablation,thereby achieving ideal surgical efficacy with few and mild complications.

关 键 词：耐药性癫痫 神经外科手术 治疗结果 MRI引导下的激光间质热疗术 脑深部致痫灶 

分 类 号：R651.12[医药卫生—外科学]