立体定向放射外科治疗功能区顽固性癫痫  

Stereotactic radiosurgery treatment on focal functional area for intractable epilepsy

作　　者：漆松涛[1] 邱炳辉[1] 杨开军[1] 刘承勇[1] 王克万[1] 

机构地区：[1]广州第一军医大学南方医院神经外科,510515

出　　处：《立体定向和功能性神经外科杂志》2002年第4期213-216,共4页Chinese Journal of Stereotactic and Functional Neurosurgery

摘　　要：目的　探讨脑重要功能区局部致痫灶顽固性癫痫的立体定向放射外科治疗新方法 ,提高手术疗效。方法　 1999年 12月～ 2 0 0 1年 2月 ,对 30例 (男 18例 ,女 12例 ,平均年龄 2 3.1岁 )顽固性癫痫病人术前借助EEG ,MRI和PET联合定位 ,致痫灶均位于脑重要功能区 ,并采用PET辅助引导、BrainScanX刀治疗系统以致痫灶为靶区进行立体定向放射外科治疗 ,周边剂量 9～ 11Gy。所有病人随访 12～ 2 4个月 ,定期比较治疗前后的EEG结果并观察疗效。结果　治疗组X刀治疗后 3月、6月、12月、2 4月复查EEG明显改善或正常 ,同时发作频率明显下降。按国际抗痫联盟Wieser外科手术疗效分类法进行疗效判定 ,1～ 2级 6 0 % ,3～ 4级 2 3.3% ,5～ 6级 16 .7%。结论　探讨了立体定向放射外科治疗功能区顽固性癫痫的方法和机理 ,并与多处软脑膜下横切术作比较后 。Objective To explore the new method of stereotactic radiosurgery treatment on focal functional area for intractable epilepsy and increase the effect of epilepsy surgery. Methods 30 patients(M18,F12,average age 23.1)with intractable epilepsy were diagnosed by the aid of EEG, MRI and PET. All the epileptogenic foci were involve the functional area. And all patients were treated by BrainScan X-knife with 9～11 Gy peripherel dosage by the aid of PET. All the patients had a follow-up period of 12-24 months observed the surgical outcome and compared the EEG results between the presurgery and postsurgery. Results EEG result was studied each group in 3,6,12,24 months postoperatively and abnormal EEG was modified obviously or tumed into normal after treatment. And the seizure frequency also decreased postoperatively. According to Wieser's classification of operative effect accepted by International League Against Epilepsy on Sept. 22. 2000,60%(18/30) was classified as grade 1 or 2, 23.3%(7/30) as grade 3 or 4 and 16.7%(5/30) as grade 5 or 6. Conclusions After the discussion of the method and mechanism of stereotactic radiosurgery on focal functional area for intractable epilepsy and the compared with the method of multiple subpial transection, we point out that this approach is an effective and very hopeful method to treatment the functional area epilepsy.

关 键 词：立体定向放射外科 治疗 功能区顽固性癫痫 

分 类 号：R742.1[医药卫生—神经病学与精神病学]