功能性磁共振导航结合皮质电极描记切除功能区及其附近的癫癎灶

Application of fMRI-navigation and electrocorticography in the resection of epileptogenic focus in or surrounding the functional area

目的探讨利用fMRI导航结合皮质电极描记切除功能区及其附近癫癎灶的临床疗效。方法回顾性分析11例癫癎灶起源于功能区及其附近的癫癎病人的手术经验。病人术前发作频率(2.63±1.68)次/月。术前利用fMRI检查确定功能区位置并与导航图像进行融合,术中使用皮质电极描记标记出癫癎波的位置,通过导航系统了解功能区与癫癎波起源的关系。在保留功能区皮质的基础上,将病灶和癫癎波起源处皮质切除,而位于功能区皮质上的癫癎波起源处则给予小功率皮质热灼。结果皮质发育不全8例,灰质异位症2例,脑外伤后局部皮质软化1例。术后随访6～12个月,癫癎发作完全消失9例,术后3～6d内发作1次2例,随后未再出现癫癎发作。术后未出现明显的神经功能损害加重的情况。术后3个月复查脑电图显示基本正常。结论fMRI导航结合皮质电极描记切除起源于功能区及其附近的癫癎灶是一种微侵袭的手术方法,在切除癫癎灶的同时能最大限度地保留功能区的神经功能。

Objective To explorevthe surgical method tbr and therapeutic effect ofresecting epileptogenic focus in or around functional area by functional magnetic resonance imaging （fMRI）-navigation and electrocorticography. Methods Surgical experience of 11 patients with epilepsy originated in or around functional areas was analyzed retrospectively. The seizure frequency was 2.63±1.68 times per month. Before operation, all the patients underwent fMRI, and the functional area localizations were fused with navigational imaging. During operation, the epileptogenic focus was marked by electrocorticography, and the position relation between functional areas and the origin of epilepsy waves was determined by neuronavigation system. The epileptic focus and cortex generating epilepsy waves were resected, and the thermocouple was used to maintain the function of the cortex. Results The cortex hypoplasia was observed in 8 cases, heterotopic gray matter in 2, and locally traumatic encephalodialysis in 1. The follow-up period was 6-12 months. The epilepsy vanished in 9 patients, and generated one time in 3-6 days after operation without regeneration afterward in 2. Furthermore, the aggravation of cerebral fimction impairment was not observed obviously in all the cases after operation, and the electroencephalograms of all the patients were approximately normal in 3 months after operation. Conclusion Resecting epileptogenic focus in or around functional area under fMRI navigation with electrocorticography is a minimally invasive neurosurgery and could perfectly maintain the cerebral functions of functional areas.