额叶癫癎的致癎灶定位与手术治疗

The localization of epileptogenic zones and surgical treatment for frontal lobe epilepsy.

目的 探讨额叶癫癎的致痴灶定位和手术治疗的策略。方法 分析29例额叶癫癎患者的术前综合定位、术中皮层脑电图监测、术式选择及术后效果的临床资料。结果 影像学检查结合长程视频脑电图监测,可以为12例定位致癎灶;而结合颅内脑电图长程记录,24例可以定位致癎灶,其中包括10例影像学检查阴性的病例。随访1年以上,按照Engel’s效果分级:Ⅰ级13例,Ⅱ级7例,Ⅲ级4例,Ⅳ级5例。结论 影像学检查、长程视频脑电图监测以及颅内脑电图长程记录和术中皮层脑电图监测相结合的综合定位方法,可以提高额叶癫癎的致癎灶定位效果和手术疗效,其中颅内电极记录尤其有助于定位影像学检查阴性病例的致癎灶。

Objective The goal of the current study was to evaluate the method of localization of epileptogenic zones and the outcome of surgical treatment in patients with frontal lobe epilepsy. Methods We retrospectively analyzed the data of 29 cases about the topical diagnosis before opereation, electrocorticography monitoring, and the outcome of the operation. Results Epileptogenic zones were found in 12 patients by MR, CT scanning and long term video-EEG monitoring, and in 24 patients when long-term intracranial encephalic electrical recording was further performed including. 10 of them with normal MR. All patients were followed up for more than 1 year. According to Engel's 13 patients were class ified as grade Ⅰ, 7 as grade Ⅱ , 4 as grade Ⅲ and 5 as grade Ⅳ. Conclusions MR, video-EEG, long-term intracranial encephalic electrical recording and electrocorticography monitoring all played important roles in the surgical treatment for frontal lobe epilepsy. Long-term intracranial encephalic electrical recording obviously contributed to revealing the epileptogenic zone, especially when a preoperative MR did not demonstrate any structural lesions.