摘要
目的评估发作期SPECT在儿童难治性癫痫外科治疗术前评估中的价值。方法对11例曾经癫痫外科治疗前行发作期SPECT检查的患儿进行了回顾性分析。11例患者中有6例患者是局限性灰质异构(FCD),2例是缺血后的继发性损伤,1例是脑炎后损伤,还有2例病理诊断不明。11例患者术前均行发作间期SPECT或PET检查及发作期SPECT检查,通过对比观察两次检查的差异与手术切除区域进行对比。11例患者中9例患者是在癫痫发作过程中注射的SPECT示踪剂,另2例患者是在发作结束后立刻注射SPECT示踪剂。结果发作期SPECT显示:10例患者发作期有局部血流灌注增强,有1例患者未发现局部血流灌注增强。11例患者中有4例患者的颅内脑电记录提示与发作期SPECT有同样的异常部位,3例显示与核磁共振检查结果相一致;6例患者行局部切除术,另外5例患者由于不能局限病变的位置,最终进行多处软膜下横切手术。6例局部切除术患者术后发作完全消失,5例多处软膜下横切手术患者中,术后2例发作消失,2例发作显著减少,1例无效。结论发作期SPECT在儿童局限性癫痫术前评估中具有很大价值,对癫痫灶位置判断的准确性好。
Objective To evaluate the role of ictal SPECT for surgical treatment of intractable epilepsy in children. Methods 11 surgical cases of children with intractable epilepsy and with ictal SPECT were retrospectively investigated. The etiology for epilepsy are focal cortical dysplasia for 6 cases,ischemic brain damagefor 2, and post - encephalitis for 1 and still unclear for 2. The ictal SPECT were performed immediately at seizure onset in 9 cases and 2 cases just after seizures. The results of ictal SPECT were interpreted with the comparison of interictal PET or interictal SPECT. Results Ictal SPECT showed that focal brain blood increase in 10 cases and one had no change. The intracranial EEG of 4 cases showed the same results of ictal SPECT. After operations, 6 patients with cortical resection and 2 patients with disconnection got Engel＇s class Ⅰ seizure control;2 patients with disconnection got Engel＇s class Ⅱ seizure control and one patient had no improvement. Conclusion Ictal SPECT plays an important role in preoperative evaluation for children with intractable epilepsy, and it can localize epileptogentic zone effectively.
出处
《立体定向和功能性神经外科杂志》
2005年第5期271-274,共4页
Chinese Journal of Stereotactic and Functional Neurosurgery
