颅内电极脑电图监测在癫疒间外科的应用(附29例分析)

Application of invasive evaluation in epilepsy surgery: analysis of 29 cases

目的探讨颅内电极置入术在临床的应用时机、方法,评估颅内电极脑电图(i-EEG)技术在癫疒间外科中的价值。方法回顾性分析29例难治性癫疒间病例,在参考非侵入性评估结果的基础上,采用颅内电极置入、长程脑电图监测技术进行可能的致疒间区定位。结合术后癫疒间控制情况和随访记录,综合分析i-EEG在术前评估中的作用。结果联合置入深部电极和硬膜下条状皮质电极14例,其中深部电极置入双侧海马10例,双侧海马-杏仁核4例;单纯置入硬膜下条状皮质电极4例;置入硬膜下条状和栅状皮质电极7例;置入硬膜外条状和栅状电极4例。电极留置颅内3￣14d,平均5.5d;监测时间24￣160h,平均38h;捕捉到临床发作5￣58次,平均7.8次。置入电极后,17例(58.6%)出现暂时性脑脊液外漏,3例出现颅内少量血肿,1例出现深部电极折断。无感染和死亡病例。手术27例,随访4￣30个月;EngelⅠ级19例,Ⅱ级4例,Ⅲ级4例。结论对难治性癫疒间而言,当非侵入性评估结果难以确定可能的致疒间区时,采用颅内电极置入并进行长程脑电图监测是定位可能致疒间区一种有效、安全的方法。

Objective To explore the time and method of intracranial electrodes placement and investigate the value and role of intracranial EEG （i-EEG） technique in intractable epilepsy pre-operative evaluation. Methods Twenty-nine cases of intractable epilepsy were retrospectively analyzed, and the epileptic zone was located by intracranial electrodes placement and i-EEG long-term monitoring based on non-invasive conclusions. The function of i-EEG was evaluated by combination of postoperative epilepsy control and follow-up record before the operation. Results Subdural cortical strip and deep electrode placement under CT and MRI stereotactic guidance were carried out in 14 patients, including 10 deep electrode placement in the bilateral hippocampus and 4 in the bilateral amygdata-hippocampus. Subdural cortical strip placement was used in 4 cases, strip and grid placement in 7, extradural strip and grid placement in 4. The electrodes were implanted for 3-14 days （mean 5.5 days）, and the monitoring time lasted from 24 to 160 hours （mean 38 hours）, 5 to 58 times （mean 7.8 times） of epileptic seizures were recorded during the monitoring. After the electrode placement, 17 patients （58.6%） had a temporary CSF leaking, 3 had less subdural hematoma, 1 had deep electrode disjunction, and no infection and death occurred. Based on 4-30 months follow-up of 27 operative patients, 19 had excellent result （Engel class Ⅰ ）, 4 Engel class Ⅱ, and 4 Engel class Ⅲ. Conclusion The intracranial EEG monitoring technique, based on the non-invasive evaluations, is an effective method localizing the epileptic zone in the intractable epilepsy.