立体脑电图电极置入在药物难治性局灶性癫痫术前评估中的应用价值  

The application value of stereoelectroencephalogram electrode implantation in the preoperative evaluation of refractory focal epilepsy

作　　者：郭效东 路小奇 刘明辉 王振华 许鹏 杨新超 郝文明 娄云霄 李经纶 王本瀚 Guo Xiaodong;Lu Xiaoqi;Liu Minghui;Wang Zhenhua;Xu Peng;Yang Xinchao;Hao Wenming;Lou Yunxiao;Li Jinglun;Wang Benhan(Neurosurgery Center,No.988 Hospital of the PLA Joint Logistic Support Force,Zhengzhou 450042,China)

机构地区：[1]解放军联勤保障部队第988医院全军神经外科中心,郑州450042

出　　处：《中华神经外科杂志》2024年第2期137-142,共6页Chinese Journal of Neurosurgery

基　　金：河南省医学科技攻关计划省部共建重点项目(SBGJ202102205)。

摘　　要：目的 探讨立体脑电图(SEEG)电极置入在药物难治性局灶性癫痫术前评估中的应用价值.方法 回顾性分析2018年1月至2022年12月解放军联勤保障部队第988医院全军神经外科中心应用少量SEEG电极置入技术评估24例药物难治性局灶性癫痫患者的临床资料,通过发作症状,发作期及发作间期视频脑电图,头颅CT、MRI、正电子发射断层显像(PET)-CT等影像学资料,依据解剖-电生理-临床表现,提出癫痫发作起源和扩散路径的核心及备用假设;将电极置入癫痫网络的相关靶点,SEEG监测判断癫痫起源区;通过皮质电刺激(ECS)诱发惯常发作验证致痫区、定位功能区后行射频热凝(RFTC)毁损治疗,仍有癫痫发作者行二期开颅手术切除致痫灶;采用Engel分级评估癫痫的控制效果.结果 24例患者共置入126根电极,每例置入(5.3±1.1)根(3~8根).单侧电极置入6例,双侧电极置入18例.24例患者的实际靶点与计划靶点误差为(1.61±0.88)mm.无一例患者补充置入电极.SEEG监测时间为(10.1±2.6)d,均捕捉到3~20次惯常发作.ECS诱发出惯常发作15例,非惯常发作5例,未诱发出发作4例.明确致痫区23例,其中颞叶、额叶各10例,枕叶3例;未能定位1例.行RFTC治疗22例,毁损后出现头痛9例、严重脑水肿致对侧上肢无力1例,无症状硬膜下血肿1例,均无颅内感染、脑脊液漏、电极折断移位等并发症发生.未行RFTC治疗2例,其中1例未能验证假设,1例致痫区与运动语言区重叠,调整抗癫痫发作药物后均好转.24例患者均获得临床随访,随访时间[M(Q1,Q3)]为12.5(10.2,26.8)个月,末次随访显示,22例行RFTC治疗的患者中,Engel分级Ⅰ级1例;Engel分级Ⅱ级21例,其中16例行二期手术切除致痫区,切除术后癫痫发作消失13例(Engel分级Ⅰ级),无改善3例(Engel分级Ⅱ级),5例拟行二次电极置入RFTC治疗.结论 合理掌握适应证,采用少量SEEG电极置入可帮助判断致痫区部位,指导手术切除致�ObjectiveTo explore the application value of stereoelectroencephalogram(SEEG)electrode implantation in the preoperative evaluation of refractory focal epilepsy.MethodsA retrospective analysis was performed on the clinical data of 24 patients with refractory focal epilepsy who were treated in the Neurosurgery Center,No.988 Hospital of the PLA Joint Logistics Support Force from January 2018 to December 2022 using a relatively small number of SEEG electrodes.Based on the patient′s symptoms,ictal and interictal video-EEG,brain CT,MRI,positron emission tomography(PET)-CT and other imaging data as well as anatomo-electrophysiology-clinical correlation,the hypothesis regarding the seizure onset and propagation network was made.SEEG electrodes were implanted into relevant targets of the seizure network.SEEG monitoring was performed to determine the seizure onset zone.Electrical cortical stimulation(ECS)was administered to induce habitual seizures to verify the epileptogenic zone and locate functional areas.Radiofrequency thermal coagulation(RFTC)was then performed.Those who still had epileptic seizures underwent secondary craniotomy to remove the epileptogenic zone.The Engel classification system was used to evaluate the effect of seizure control.ResultsA total of 126 electrodes were implanted in 24 patients,with 3 to 8 electrodes implanted in each case,with an average of 5.3±1.1 electrodes/case.There were 6 cases of unilateral electrode implantation and 18 cases of bilateral electrode implantation.The error between the actual target point and the planned target point was 1.61±0.88 mm in 24 patients.No patient had additional implanted electrodes.The SEEG monitoring time was 10.1±2.6 days,and 3 to 20 habitual seizures were recorded.ECS induced habitual seizures in 15 cases,non-habitual seizures in 5 cases,and no seizures in 4 cases.The epileptogenic zone was identified in 23 cases,including 10 cases in the temporal lobe,10 cases in the frontal lobe,and 3 cases in the occipital lobe.The seizure onset could not be loca

关 键 词：耐药性癫痫 致痫区 立体脑电图 射频热凝毁损 皮质电刺激 

分 类 号：R651.12[医药卫生—外科学]