岛叶及岛叶周围皮层癫痫的术前综合定位分析

A clinical study on the presurgical localization of the epileptogenic zones for patients with insular/ peri-insular cortex epilepsy

目的 初步探讨岛叶及岛叶周围皮层癫痫的术前定位评估方法.方法 回顾性分析2011年1月-2015年4月期间,通过症状学分析、头皮脑电图(EEG)、磁共振(MRI)、脑磁图(MEG)及颅内电极检查定位为岛叶及岛叶周围皮层癫痫,并接受手术治疗病例的临床资料,分析各项检查在致痫灶定位中的作用.结果 共18例患者符合入组标准,无创检查提示岛叶及岛叶周围皮层癫痫为:症状学分析16例,MRI 6例,MEG 17例,其中在MRI阴性表现的12例患者中,MEG具有明确定位作用的11例,MEG的定位作用显著强于MRI,差异具有统计学意义(P<0.05).13例埋藏了颅内电极,根据MEG检查结果,3例免除了埋藏颅内电极进行监测,直接手术切除致痫灶;5例调整了颅内电极埋藏方案.18例患者均进行了局灶性脑皮质切除,包括岛盖及部分岛叶皮层.术后随访12 ~48个月,失访2例,发作消失11例(61.1%).结论 症状学分析、头皮EEG、MRI和MEG检查相结合,对岛叶及岛叶周围皮层癫痫的定位有显著价值,其中MEG检查的定位作用非常明显.

Objective To evaluate the role of several examinations in the presurgical localization of insular peri-insular cortex epilepsy(IPICE).Methods The data of patients with IPICE who were identified by reseetive surgery from 201 1.1 to 2015.4 were retrospectively analyzed.The role of semiology,scalp EEG,MRI and magnetoencephalography(MEG)in the localization of epileptogenic zones for patients with IPICE were evaluated.Results 1 8 patients were selected according to the criteria.The loc￡dization of IPICE was supported by semielogy in 16 patients,supported by MRI in 6 patients,supported by MEG in 17 patients.In 12 patients with negative MRI,the dipoles were showed in insular/peri.insular area in 1 1 patients.The]localization role of MEG for patients with IPICE iS more obvious than that of MRI f P<0.05).The MEG result played conclusive role in 9 patients.According to result of MEG.the plans of intraeranial recording were canceled in 3 patients,and the plans of imraeranial electrodes implanting were modified in 5 patients.The reseetive surgery involving the insular/peri—insular cortex was performed in all the 1 8 patients.During the follow—up of 1 2~48 months,seizure—free was reported in 1 1 patients.although 2 patients were missed.Conclusion The combination of the results of semiology,scalp EEG.MRI and MEG was helpful in the localization of epileptogenie zones for patients with IPICE,and MEG played a valuable role in this Jlocalization.