立体脑电图引导下的射频热凝毁损技术在难治性癫痫中的应用  

Application of radiofrequency thermocoagulation guided by stereotactic electroencephalography in refractory epilepsy

作　　者：高丹丹 巩顺 刘锡禹 高阳 周旭 袁冠前 GAO Dandan;GONG Shun;LIU Xiyu;GAO Yang;ZHOU Xu;YUAN Guanqian(Department of Neurosurgery,General Hospital of the Northern Theater Command,Shenyang,Liaoning 110016,China)

机构地区：[1]中国人民解放军北部战区总医院神经外科,辽宁沈阳110016

出　　处：《中华神经外科疾病研究杂志》2024年第6期33-37,共5页Chinese Journal of Neurosurgical Disease Research

基　　金：辽宁省科技计划联合计划项目(编号:2023JH2/101700104)。

摘　　要：目的探讨立体脑电图(stereo-electroencephalography,SEEG)引导下的射频热凝毁损(radiofrequency thermocoagulation,RF-TC)技术在难治性癫痫中评估预后的作用。方法回顾性分析2021年1月至2022年6月北部战区总医院神经外科15例行SEEG引导下的RF-TC治疗的难治性癫痫患者的临床资料,年龄2-63岁,男10例,女5例。15例难治性癫痫患者,完善长程视频脑电监测(video electroencephalography,V-EEG)、头部MRI、PET等检查后,在机器人下行深部电极植入,监测发作定位明确后,均进行射频毁损治疗。结果15例患者毁损前先进行Mapping皮质电刺激,位于功能区者毁损前均进行预毁损,均在视频脑电监测下进行,预毁损有效输出功率1.1-1.5 W,时长10-15 s。毁损额定功率5-6 W,实际电极工作端输出的有效功率3-3.4 W,单次毁损总时长50 s(含升温时长15 s),温度72-76℃,毁损灶长径7-8 mm,短径5-6 mm,采用深部热凝毁损电极(法国ALCIS,电极直径0.8 mm,电极触点长度2 mm,触点间间距1.5 mm),采用相邻电极之间毁损。15例患者随访2-3年不等。8例患者毁损后EngelⅠ-Ⅲ级,7例患者毁损后进行二期手术切除,术后EngelⅠ-Ⅱ级。1例患者毁损后EngelⅢ级,调整药物治疗。结论SEEG引导的RF-TC手术是一种精准、安全的手术方式,可以减少癫痫发作。Objective To explore the role of radiofrequency thermocoagulation(RF-TC)guided by stereoscopic electroencephalography(SEEG)in evaluating prognosis of refractory epilepsy.Methods A retrospective analysis was conducted on the clinical data of 15 patients with refractory epilepsy who underwent RF-TC guided by SEEG in the neurosurgery department of the General Hospital of the Northern Theater Command from January 2021 to June 2022.Aged from 2 to 63 years old,with 10 males and 5 females,these fifteen patients underwent comprehensive long-term video electroencephalography(V-EEG)monitoring,head MRI,PET,and other examinations.Deep electrodes were implanted under the guidance of a robot,and after monitoring the location of seizures,radiofrequency ablation therapy was performed on all patients.Results Cortical electrical stimulation Mapping was performed on these 15 patients before the lesion,and pre lesion was performed on the parts located in the functional area under V-EEG monitoring.The effective output power of pre lesion was 1.1-1.5 W,and the duration was 10-15 s.The rated power for damage was 5-6 W,and the actual effective power output of the electrode working end was 3-3.4 W.The total duration of a single damage was 50 s(including a heating time of 15 s),and the temperature was 72-76℃.The length and diameter of the damaged stove were 7-8 mm and 5-6 mm respectively.Deep thermal condensation damage electrodes(ALCIS,made in France,with a diameter of 0.8 mm,electrode contact length of 2 mm,and contact spacing of 1.5 mm)were used,and adjacent electrodes were damaged.These fifteen patients were followed up for 2-3 years.Eight of them had EngelⅠ-Ⅲgrade after destruction,and seven of them underwent secondary surgical resection after destruction,resulting in EngelⅠ-Ⅱgrade after surgery.One patient had EngelⅢgrade after destruction,and medication treatment was adjusted.Conclusions RF-TC guided by SEEG surgery is a precise and safe surgical approach that can reduce epileptic seizures.

关 键 词：立体脑电图 药物难治性癫痫 射频热凝毁损 

分 类 号：R742.1[医药卫生—神经病学与精神病学]