皮层脑电监测下颞叶病变合并癫的手术治疗

Surgical treatment effects of ECoG monitoring in epilepsy patients with temporal lobe lesions

目的探讨皮层脑电监测下合并颞叶病变的癫手术治疗效果。方法 21例伴有癫症状的颞叶病变患者,术中通过皮层脑电图确定癫灶,切除病变后,切除或热灼可疑癫疒间灶。术后随访患者的癫发作情况。结果 21例患者切除颞叶病变前均可通过皮层脑电图探及疒间波,病变及疒间灶完全切除后,癫波消失者19例,2例功能区患者虽多次皮层热灼,仍可见偶发棘波。术后20例未再有癫疒间发作,1例有部分性发作,用抗癫疒间药可控制。结论术中皮层脑电监测切除或热灼癫灶是一种有效控制颞叶病变切除术后癫发作的方法。

Objective To explore the surgical treatment effects of ECoG monitoring in epilepsy patients with temporal lobe lesions.Methods ECoG monitoring system was used on 21 epilepsy patients with temporal lobe lesions in operation for accurate localization of the epileptogenic zone by detecting the target cortex of the epileptogenic zone with cortical electrodes before operation.Then the epileptogenic focus was removed by using hot burning epileptogenic zone according ECoG records.Antiepileptic drugs were used after operation.Epilepsy patients were followed up the situation.Results Epileptic discharge was obtained from predicated location of epileptogenic zone in all patients by ECoG.Detection at the remove of lesion and epileptogenic zone showed that the epileptic discharge decreased obviously in 19 cases including 2 cases of cavernomas in nonfunctional area where many spike waves could still be found.These spike waves decreased obviously after extended ectomy of cortex around the tumor.After surgery,20 patients without seizures,only 1 patient had partial seizures,could be controlled with antiepileptic drugs.Conclusion ECoG monitoring during operation of Epilepsy patients with temporal lobe lesions can be effective in precise localization of epileptogenic zone.Epileptogenic zone resection or thermal burn can reduce postoperative seizure.