癫癎外科中长程视频脑电图监测的应用

THE APPLICATION ON LONG-TERM VEEG MONITORING IN EPILEPSY SURGERY

目的：探讨长程视频脑电图（VEEG）监测对癫癎发作的起源和定位的作用和意义。方法：120例患者均行长程视频脑电图检查,其中73例监测中可见明确的局灶性癎样放电,结合临床发作形式和发作期脑电图以及影像学检查,73例为症状性癫癎,且均有手术治疗的意愿,经准确定位癫癎灶后,实施手术治疗,手术中均行皮层脑电图监测（CoEEG）。23例脑电检测中发现明显癎样放电,因放电灶分散或位于功能区或因脑肿瘤伴发癫癎或患者发作不太频繁且不愿意接受开颅手术者,行伽玛刀治疗。结果：73例开颅手术者,术中均监测到皮层棘波放电。术后随访6～24个月,发作停止者70例,明显减少者2例,无显著改善者1例,有效率99%。结论：长程视频脑电监测在癫癎术前评估定位致癎灶方面具有重要意义。

Objectives ：To explore the value and role on long -term VEEG monitoring in the origin and localization of epileptogenic focus. Methods：One hundred and twenty patients with epilepsy were examined by long - term video EEG in the study. In those patients, VEEG monitoring shows that 73 patients were definite focal discharge. Based on chinical mode of seizure, EEG and image examination,73 cases were symptomatic epilepsy and were willing to prefer surgical treatment, After accurate localization of epileptogenic focus, the patient were performed operation with electrocorticogram monitoring. 23 cases with obvious epiteptiform discharge were performed gamma knife radiosurgery treatment because of scattered discharge focus, in the functional area, brain tumor accompanied epilepsy, low seizure frequency and being willing not to prefer cranioectomy treatment. Results： Senventy three patients with cranioectomy were showed cortical spike discharge during operation course. After the operation,70 cases became seizure stop,2 cases had an obvious reduction in seizure frequency, and 1 case had no significant improvement. At 6 - 24 months follow - up, effective rate was 99%. Conclusions：Long - term VEEG monitoring can play an important role in preoperative localization of epilepeogenic focus with refractory epilepsy.