难治性癫痫的病灶定位和手术治疗

Localization of the epileptogenic focus and surgical treatment of medically refractory epilepsy

目的探讨难治性癫痫的致痫灶定位和手术治疗方法。方法对150例难治性癫痫患者的临床资料作回顾性分析。结果本组术前均行冠矢状位轴位MRI检查、视频脑电图(VEEG)检查,其中20例行脑PET-CT显像;在皮质脑电图(EcoG)监测下切除致痫灶,包括局部癫痫灶切除59例,前颞叶及颞叶加杏仁核、海马切除50例,选择性杏仁核、海马切除3例,额叶病灶切除28例,额叶加颞叶病灶切除7例,大脑半球切除3例。术前MRI、VEEG和PET-CT定侧定位准确率分别为70.6%、83.5%、94.4%。术后随访1.5 a,疗效Ⅰ级(Engel分级)57例、Ⅱ级52例、Ⅲ级33例、Ⅳ级8例。结论综合应用MRI、脑电图以及核素检查可更准确地定位致痫灶,在EcoG监测下行致痫灶切除手术效果较好。

Objective To summarize the methods of localization of epileptogenic focus and surgical treatment of medically refractory epilepsy. Methods All the 150 cases of refractory epilepsy patients were examined with preoperative axial coronal sagittal MRI,video EEG（VEEG） monitoring ,in which 20 cases PET-CT imaging of the brain;Epileptogenic zone was removed when patients in the cortical electroencephalogram （EcoG） monitoring, including 59 cases of partial resection of the epileptic focus, anterior temporal lobe and temporal lobe plus amygdala, hippocampus resection of 50 cases, selective amygdala, hippocampus resection in 3 cases ,frontal lobe epileptic foci excision in 28 cases, frontal plus temporal lobe excision in 7 cases,3 cases of hemispherectomy. Results Lateralization and localization accuracy of epileptogenic focus of preoperative MRI,VEEG,and PET-CT was 70.6% ,83.5% and 94.4% respectively. Patients were followed up for 1.5 a, effect of grade I （ Engel classification） in 57 cases, II grade 52 cases, III grade 33 cases, IV grade 8 eases. Conclusions The integrated application of imaging, EEG and radionuclide examination can more accurately locate the epileptic foci, the effects of resection of epileptogenic focus will be better in EcoG monitoring.