应用脑深部电极准确定位颞叶癫痫致痫灶  

Precise localization of epileptogenic focus via application of depth electrodes for temporal lobe epilepsy

作　　者：张雯倩 王佳芮 张琳琳 朱洪静 王涛 赵全军 Zhang Wenqian;Wang Jiarui;Zhang Linlin;Zhu Hongjing;Wang Tao;Zhao Quanjun(Division Five of Research Department,Fifth Clinical Medical College,Anhui Medical University,Beijing 100101,China;Department of Neurology,Fifth Clinical Medical College,Anhui Medical University,Beijing 100101,China;Department of Neurosurgery,Strategic Support Force Medical Center,Beijing 100101,China;306th Clinical College of PLA,Fifth Clinical Medical College,Anhui Medical University,Beijing 100101,China)

机构地区：[1]战略支援部队特色医学中心研究部五室,北京100101 [2]战略支援部队特色医学中心神经内科,北京100101 [3]战略支援部队特色医学中心神经外科,北京100101 [4]安徽医科大学解放军306临床学院安徽医科大学第五临床医学院,北京100101

出　　处：《中国微侵袭神经外科杂志》2024年第1期4-7,共4页Chinese Journal of Minimally Invasive Neurosurgery

摘　　要：目的探讨脑深部电极准确定位颞叶癫痫致痫灶的临床价值。方法28例疑似颞叶癫痫病人,均实施脑深部电极植入术,均以颞叶内侧为靶点,对重点怀疑致痫灶侧,分别经额叶、颞叶外侧及顶枕叶最多植入3枚电极,对侧依情况植入1~2枚,疑似双颞叶癫痫者最多植入6枚。结果27例病人明确了致痫灶的具体部位并实施相应手术治疗,其中颞叶内侧型癫痫19例,颞叶外侧型癫痫5例,颞叶外器质性病变导致癫痫发作3例。CT/MRI显示器质性病变9例,其中1例为非致痫性病变。术后癫痫发作总消失率为62.96%(17/27),其中立体定向海马杏仁复合体毁损术5例,海马横切术3例,前颞叶切除术5例,单纯器质性病变切除术4例。结论准确应用脑深部电极,可达到颞叶癫痫致痫灶的准确定位效果并减少手术创伤,保护脑组织功能,对于颞叶外器质性病变导致的癫痫发作也有定位价值。Objective To investigate the clinical value of depth electrodes for accurate localization of epileptogenic focus in temporal lobe epilepsy.Methods The depth electrodes of brain were implanted for 28 patients who were suspected of temporal lobe epilepsy.At most 3 electrodes were implanted as the targets in the medial temporal lobe and trajectories via frontal lobe,lateral temporal lobe and occipital-parietal lobe respectively for the main suspected side and 1-2 electrodes for the other according to the specific circumstance.The maximum of 6 electrodes were applied to the patients who were suspected of bilateral temporal lobe epilepsy.Results The site of epileptogenic focus was confirmed and the corresponding operation was performed in 27 patients,including 19 cases of medial temporal lobe epilepsy,5 of lateral temporal lobe epilepsy,and 3 of extratemporal organic lesions caused by seizures.CT/MRI showed organic lesions occurred in 9 cases,of which 1 was non-epileptogenic lesion.The total seizurefree rate was 62.96%(17/27),in which 5 underwent stereotactic amygdalohippocampal coagulation,3 hippocampal transection,5 anterior temporal lobectomy and 4 structural lesion resection.Conclusions Accurate application of deep brain electrodes can achieve the accurate localization effect of epileptic foci caused by temporal lobe epilepsy,reduce surgical trauma,protect brain tissue function,and also have positioning value for seizures caused by extratemporal organic lesions.

关 键 词：癫痫 颞叶 经脑深部电极 立体定位技术 海马横切术 前颞叶切除术 

分 类 号：R651.11[医药卫生—外科学]