正电子发射断层扫描辅助定位脑损伤后顽固性癫痫低剂量放射外科治疗  

Low-dosage radiosurgical treatment for intractable epilepsy following brain injury through positron emission tomography localization

作　　者：王克万[1] 漆松涛[1] 武华坪[1] 杨开军[1] 

机构地区：[1]第一军医大学附属南方医院神经外科,广州510515

出　　处：《中华创伤杂志》2004年第5期259-263,共5页Chinese Journal of Trauma

摘　　要：目的　利用正电子发射断层扫描 (PET)辅助定位 ,采用低剂量射线对脑损伤后晚期顽固性癫痫患者进行立体定向放射外科治疗。　方法　 32例患者依据18F - 2 -氟 - 2 -脱氧葡萄糖 (FDG)PET显像等检查综合定位致痫灶 ,然后采用 9～ 13Gy周边剂量对致痫灶行立体定向X刀放射外科治疗。随访至少 1年以上 ,观察发作频率变化情况 ,评价治疗效果。　结果　PET表现在原发损伤脑软化病灶周围的皮层组织多呈低代谢改变 ,多为围绕损伤部位的多个区域 ,呈现多致痫灶改变。部分患者低代谢灶不仅位于原发损伤部位 ,还位于对冲伤的部位。大部分患者在治疗后癫痫发作频率及发作程度逐渐减轻 ,与治疗前相比差异具有显著性意义。经Wieser疗效评定 ,Ⅰ～Ⅱ级百分比为 4 4 % (14 / 32 ) ,Ⅲ～Ⅳ级为 4 1% (13/ 32 ) ,Ⅴ～Ⅵ级为 16 % (5 / 32 )。所有患者均未见有新的并发症发生。　结论　PET辅助定位下 ,低剂量放射外科治疗顽固性创伤性癫痫是一种有效的微侵袭外科治疗新方法。Objective To treat the patients suffering from intractable epilepsy after brain injury with low-dosage linac accelerator stereotactic radiosurgery through positron emission tomography (PET) localization. Methods PET examination based on 18 F-2-fluorine-2-deglucose (FDG) was carried out in 32 patients in order to localize epileptogenic foci followed by radiosurgery with peripheral radiation dose of 9-13 Gy. The follow-up was conducted over one year. The seizure frequency of epilepsy was recorded to evaluate the therapeutic effect. Results The PET imaging showed that the cortical area around the cerebromalacia caused by primary injury presented low metabolic change. The metabolic changes in different injury areas mainly concentrated in the epileptic foci. In some cases,the low metabolic areas not only was localized at the part of impact lesion but also at the part of contrecoup lesion. The seizure frequency gradually decreased after radiosurgical treatment in most patients,with obvious statistical significance compared with pretreatment. According to Wieser's classification of operative effect,the cases at the grades Ⅰ-Ⅱ accounted for 44% (14/32),grades Ⅲ-Ⅳ for 41% (13/32) and grades Ⅴ-Ⅵ for 16%(5/32). No fresh complications were found in all the cases. Conclusions Low-dosage stereotactic radiosurgery with the PET localization is a safe,effective and minimally invasive surgical approach to intractable posttraumatic epilepsy.

关 键 词：正电子发射断层扫描 辅助定位 脑损伤 顽固性癫痫 低剂量放射疗法 立体定向放射外科 

分 类 号：R651.1[医药卫生—外科学]