头皮EEG偶极子定位在癫外科中的应用研究

Study of dipole source imaging for pre-operative localization of the epileptogenic discharges in patients with intractable epilepsy

目的 :研究头皮EEG偶极子定位方法在癫手术病人中的应用价值及其准确性。方法 :在 80例难治性癫手术病人中 ,术前在发作间期头皮EEG上用偶极子定位方法定出致源放电位置 ,术中以皮质电图 (ECoG)及脑深部电极记录确定致区 ,对比偶极子定位的准确性 ,按ECoG定出的位置直接对致区进行手术处理 ,术后随访手术效果。结果 :在颞叶癫 ,偶极子定位与ECoG及脑深部电极定位完全一致 ;在额、顶、枕叶癫 ,偶极子位置误差为 10～ 15mm。随访 6～ 2 4个月 (平均 13个月 ) ,80例中 71%的病人无癫发作 ,2 5 %的病人发作减少 75 %以上 ,手术有效率 96 %。结论 :头皮EEG的偶极子定位方法无创、准确 ,相当于脑磁图 ,可避免创伤性检查而用于癫病人的术前定位。

Objective:To explore the feasiability of dipole source imaging for pre-surgical localization of the epileptogenic zone in patients with intractable epilepsy. Methods:To compare the accuracy of the localization of epileptogenic zone by pre-surgical scalp EEG dipole source imaging and ECoG during operation in 80 patients with intractable epilepsy. Results:For localization of the epileptogenic zone, dipole source imaging has no error in temporal lobe epilepsy and has an error with a tolerance of less than 15 mm in extra-temporal lobe epilepsy. Conclusions:The error of localization for epileptogenic zone by dipole source imaging from a scalp EEG is quite small and it can be used and instead of the invasive recordings in pre-surgical localization of the epileptgenic zone for epilepsy surgery.