立体定向脑电图辅助灰质异位致癫痫患者手术方式选择分析  

Analysis of the operative manner selection of patients with heterotopic gray matter induced epilepsy assisted by stereotactic electroencephalogram

作　　者：张伟 井晓荣 马炜 卫晨 赵德昌 刘备 王超 ZHANG Wei;JING Xiaorong;MA Wei;WEI Chen;ZHAO Dechang;LIU Bei;WANG Chao(Department of Neurosurgery,Tangdu Hospital,Air Force Medical University,Xi'an 710038,China)

机构地区：[1]空军军医大学唐都医院神经外科,陕西西安710038

出　　处：《空军军医大学学报》2024年第12期1432-1434,1440,共4页Journal of Air Force Medical University

基　　金：国家自然科学基金面上项目(81971206)。

摘　　要：目的分析立体定向脑电图(SEEG)在灰质异位致癫痫的术前评估的价值,探讨不同类型灰质异位导致癫痫患者的手术方式选择。方法回顾性分析2019年4月至2022年5月在空军军医大学唐都医院神经外科治疗的16例药物难治性灰质异位致癫痫的患者,其中脑室周围灰质异位(PNH)单发结节7例,双侧PNH多发结节2例,皮层下灰质异位伴局部皮质发育不良7例,经无创性术前评估后行机器人辅助SEEG置入,根据SEEG及电刺激结果,个体化选择不同治疗方式,均随访1年以上。结果7例脑室旁单发异位灰质结节的患者,采用SEEG引导射频热凝治疗,术后随访1年,5例疗效达到EngelⅠ级,2例为EngelⅡ级;2例脑室周围多发灰质异位结节的患者采用迷走神经刺激术治疗,随访2年,EngelⅣ级;4例皮层下异位灰质和被覆皮层均有异常放电的患者采用切除异位灰质及相关皮层;3例患者异常放电为被覆皮层独立起始,仅切除相关皮层,术后随访1~3年不等,疗效达到EngelⅠ级。结论灰质异位导致的癫痫往往属于药物难治性癫痫,SEEG在癫痫病灶定位方面起到重要作用,针对不同类型制定个体化手术策略,可取得满意疗效。Objective To analyze the value of stereotactic electroencephalogram(SEEG)in preoperative evaluation of epilepsy caused by heterotopic gray matter,and to explore the operative manner selection for patients with epilepsy caused by different types of heterotopic gray matter.Methods A retrospective analysis was performed on 16 patients with drug-refractory epilepsy induced by heterotopic gray matter treated in Department of Neurosurgery,Tangdu Hospital,Air Force Medical University from April 2019 to May 2022.Among them,there were 7 cases of single nodule in periventricular nodular heterotopia(PNH),2 cases of bilateral PNH with multiple nodules,and 7 cases of subcortical heterotopia with local cortical dysplasia.After non-invasive preoperative evaluation,robot-assisted SEEG implantation was performed.According to the results of SEEG and electrical stimulation,different operative manners were individually selected.All patients were followed up for more than 1 year.Results Seven cases of single nodule in PNH were treated with SEEG-guided radiofrequency thermocoagulation.After 1 year of postoperative follow-up,5 cases achieved EngelⅠand 2 cases achieved EngelⅡ.Two patients with multiple nodules in PNH were treated with vagus nerve stimulation and followed up for 2 years,with the effect reaching EngelⅣ.Four patients with abnormal discharge of subcortical heterotopic gray matter and covered cortex were treated with excision of heterotopic gray matter and related cortex.The abnormal discharge in 3 patients started independently from the covered cortex,and the relevant cortex was resected only.The postoperative follow-up ranged from 1 to 3 years,and the efficacy reached EngelⅠ.Conclusion Epilepsy caused by heterotopic gray matter often belongs to drug-refractory epilepsy.SEEG plays an important role in the localization of epilepsy foci.Individualized operative manners for different types can achieve satisfactory results.

关 键 词：灰质异位 药物难治性癫痫 立体定向脑电图 射频热凝治疗 迷走神经刺激术 

分 类 号：R651.1[医药卫生—外科学]