质子磁共振波谱结合皮层脑电图用于术中致痫灶的定位

Evaluation of proton magnetic resonance spectroscopy associated with electrocorticography for localization of epileptogenic focus

目的探讨质子磁共振波谱(1HMRS)分析结合术中皮层脑电图(ECoG)在结构性病变伴发癫痫手术中对致痫灶定位的意义。方法选择10例在同济医院接受系统术前评估和手术治疗、术后病检证实为结构性病变的患者为研究对象,术前行1HMRS检查,术中行ECoG描记。根据术中切除前ECoG检查结果将患者分为异常放电频繁组和少量或无异常放电组。将发现异常放电的区域与术前1HMRS检查结果进行对照,分析1HMRS与皮层异常放电的关系。结果切除病灶前行病灶周边ECoG描记,8例发现异常放电(80%),其中异常放电(棘波和/或棘慢波)频繁者6例,2例仅散发异常放电(25%);2例ECoG阴性(20%)。术中ECoG异常放电频繁组NAA/(Cr+Cho)比值平均为0.55±0.22(0.24～0.85),少量或无异常放电组NAA/(Cr+Cho)比值平均为0.83±0.10(0.74～0.92),两组差异有显著性意义(P<0.05)。结论1HMRS作为一种无创性、高敏感性的检查方法,可在癫痫外科术前非侵袭性评估中发挥重要作用,并且与术中ECoG发现相结合,可提高致痫灶定位的准确率,从而有助于进一步改善癫痫手术的效果。

Objective To evaluate the value of proton magnetic resonance spectroscopy （1H MRS） associated with electrocorticography （ECoG） in the localization of epileptogenic focus. Methods Ten cases with structral lesions and epilepsy operated in our epilepsy center were studied. ^1H MRS and intraoperative ECoG were performed in all 10 cases. Based on ECoG findings, 10 cases were divided into two grous： Group 1 with frequent epileptiform discharges （EDs） and Group 2 with infrequent or no epileptiform discharges. Assocoation of ECoG findings and 1 H MRS results was studied. Results EDs were recorded in 8 cases （80%）. Among them,, frequent EDs were found in 6 cases, and sporadic EDs in 2 cases. No EDs were recorded in the rest 2 cases （20%）. The mean NAA/（Cr ＋ Cho）ratio was 0. 55 ± 0. 22（0. 24-0. 85）in Group 1 and 0. 83 ± 0. 10（0. 74- 0. 92）in Group 2. The difference was statistically significant （P〈0. 05）. Conclusion ^1H MRS is a useful noninvasive technique for presurgical evaluation of patients with structral lesions and epilepsy. Combination of ^1H MRS and ECoG may help improve the localization of the epileptigenic focus during epilepsy surgery.