立体脑电图引导射频热凝治疗颞叶内侧型癫痫的长期疗效观察  

Observation on the long-term efficacy of stereoelectroencephalography-guided radiofrequency thermocoagulation in the treatment of mesial temporal lobe epilepsy

作　　者：夏春生 游龙飞 彭昶 汪兰兰 张栋[1] 齐印宝 刘向 钱若兵 Xia Chunsheng;You Longfei;Peng Chang;Wang Lanlan;Zhang Dong;Qi Yinbao;Liu Xiang;Qian Ruobing(Department of Neurosurgery,the First Affiliated Hospital of University of Science and Technology of China(Anhui Provincial Hospital),Hefei 230001,China;Department of Neurosurgery,Chaohu Hospital of Anhui Medical University,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]安徽医科大学附属巢湖医院神经外科,合肥230001

出　　处：《中华神经外科杂志》2024年第8期827-831,共5页Chinese Journal of Neurosurgery

摘　　要：目的探讨颞叶内侧型癫痫患者采用立体脑电图(SEEG)引导射频热凝(RFTC)治疗的长期效果。方法回顾性分析2019年4月至2020年12月中国科学技术大学附属第一医院(安徽省立医院)神经外科采用SEEG引导RFTC治疗且随访时间满36个月的23例颞叶内侧型癫痫患者的临床资料。所有患者进行完整的Ⅰ期、Ⅱ期癫痫术前评估,依据症状学-脑电图-多模态影像等资料综合设计电极置入方案,确定为颞叶内侧型癫痫,通过SEEG电极进行适形毁损。术后3、6、12、24、36个月进行门诊或电话随访,采用改良Engel分级评估手术疗效,以Ⅰ、Ⅱ级为RFTC治疗有效;随访期间,若患者行前颞叶切除术,记为RFTC治疗无效。根据RFTC术前可否通过电刺激诱导惯常发作将患者分为诱发出惯常发作组与未诱发出惯常发作组,比较两组患者手术前、后的癫痫发作频率。结果23例患者均顺利完成RFTC手术,无明显不良事件发生。术后3个月随访时,改良Engel分级Ⅰ级14例(60.9%),Ⅱ级8例(34.8%),Ⅳ级1例(4.3%);RFTC治疗有效率为95.6%(22/23);其中,14例改良Engel分级Ⅰ级患者术前电刺激均诱发出惯常发作。随访期间,9例患者行前颞叶切除术,术后的随访时间[M(Q_(1),Q_(3))]为26(18,30)个月,达到改良Engel分级Ⅰa级8例,Ⅱ级1例。至末次随访,RFTC治疗有效率为13.0%(3/23)。诱发出惯常发作组(17例)与未诱发出惯常发作组(6例)患者的术前癫痫发作频率[M(Q_(1),Q_(3))]分别为6.00(5.00,10.00)次/月和8.00(5.25,17.50)次/月(P=0.804);诱发出惯常发作组较未诱发出惯常发作组患者术后3个月的癫痫发作频率更低[M(Q_(1),Q_(3))分别为0.17(0,4.00)次/月和5.00(2.50,10.50)次/月,P=0.022]。与术前比较,两组患者术后3个月的癫痫发作频率均下降(均P<0.05)。结论SEEG引导RFTC治疗颞叶内侧型癫痫的短期有效率较高,术前电刺激可诱发出惯常发作的患者效果更佳;但随着时间的延长,有效率下降,Objective To explore the long-term effects of stereoelectroencephalography(SEEG)-guided radiofrequency thermocoagulation(RFTC)in patients with mesial temporal lobe epilepsy.Methods A retrospective analysis was performed on the clinical data of 23 patients with mesial temporal lobe epilepsy who were treated with SEEG-guided RFTC at the Neurosurgery Department of the First Affiliated Hospital of University of Science and Technology of China(Anhui Provincial Hospital)from April 2019 to December 2020 and with a follow-up time of 36 months.All patients underwent a complete preoperative epilepsy evaluation of stageⅠand stageⅡ,and an electrode placement plan was comprehensively designed based on symptomatology,electroencephalography,multimodal imaging and other data.The cases were determined to be mesial temporal lobe epilepsy,and SEEG electrodes were used for conformal damage.Outpatient or telephone follow-up was conducted at 3,6,12,24,and 36 months after surgery.The modified Engel classification was used to evaluate the surgical efficacy.Modified Engel gradeⅠandⅡwere considered effective in RFTC treatment.During the follow-up period,if the patient underwent anterior temporal lobectomy surgery,the case was recorded as ineffective RFTC treatment.According to whether habitual seizures were induced by electrical stimulation before RFTC surgery,patients were divided into a group with habitual seizures induced and a group without habitual seizures induced.The frequency of epileptic seizures before and after surgery was compared between the two groups.Results All 23 patients underwent successful RFTC surgery without obvious adverse events.At the 3-month follow-up after surgery,14 cases(60.9%)were classified as Engel gradeⅠ(60.9%),8(34.8%)as gradeⅡ,and 1(4.3%)as gradeⅣ.The effective rate of RFTC treatment was 95.6%(22/23).Among them,all 14 patients with modified Engel classification gradeⅠhad habitual seizures induced by preoperative electrical stimulation.During the follow-up period,9 patients underwent anter

关 键 词：癫痫 颞叶 立体定位技术 治疗结果 射频热凝术 

分 类 号：R651.1[医药卫生—外科学]