脑磁图、视频脑电图在癫术前评估中的应用

Preoperative location of epileptogenic focus in refractory epilepsy surgery:magnetoencephalography vs video-electroencephalography

目的探讨脑磁图(magnetoencephalography,MEG)、视频脑电图(video-electroencephalography,V-EEG)、单光子发射计算断层扫描(single photon emission computed tomography,SPECT)、正电子发射断层扫描(positron emission tomo-graphy,PET)技术术前定位癫致灶的准确性。方法癫手术患者73例,术前均采用MEG、V-EEG行致灶定位,其中52例加行V-EEG+蝶骨电极记录,19例加行PET致灶定位,48例加行SPECT定位。结果通过与术中皮层脑电图(ECoG)结果的比较,73例癫患者中术前MEG定位与术中ECoG致灶定位符合者66例,准确率90.41%;V-EEG定位与术中ECoG致灶定位符合者44例,准确率60.27%;52例癫行V-EEG+蝶骨电极描记,与术中ECoG致灶定位符合者34例,准确率为65.39%;19例行PET检查,与术中ECoG致灶定位符合者10例,准确率为52.63%;48例行SPECT检查,与术中ECoG致灶定位符合者23例,准确率为47.92%。MEG分别与V-EEG、V-EEG+蝶骨电极、PET、SPECT比较差异有统计学意义(P<0.05)。14例海马硬化所致颞叶癫患者,术前MEG定位与术中ECoG致灶定位符合者8例,准确率57.14%,V-EEG+蝶骨电极定位与术中ECoG致灶定位符合者12例,准确率85.71%,V-EEG+蝶骨电极与MEG比较差异有统计学意义(P<0.05)。结论MEG可提高术前致灶定位的准确率;对于颞叶内侧深部癫而言,术前定位以V-EEG+蝶骨电极记录更准确。

Objective To compare the accuracy between magnetoencephalography （MEG） and video- eleetroeneephalography （V-EEG）, single photon emission computed tomography （SPECT） or positron emission tomography （PET） for preoperative location of epileptogenic focus in patients with refractory epilepsy. Methods MEG and V-EEG were performed on 73 patients with refractory epilepsy to determinate the epileptogenic focuses for operation. Fifty-two of them were examined by V-EEG plus sphenoidal electrode, 19 by PET, and 48 by SPECT at the same time. Epileptogenic focus resection were performed under the direction of intraoperative electroeorticography （ECoG） in all of these 73 cases. The accuracy of pre- and intra-operative techniques for detecting epileptogenie focus were analyzed. Results Out of the 73 cases, epileptogenie focus were detected by preoperative MEG in 66 cases, with an accuracy rate of 90.41%, by V-EEG in 44 cases （60. 27% ）. Among the 52 cases detected by preoperative V-EEG plus sphenoidal electrode, the accuracy was 65.39% （34 cases）, and for the 19 cases by PET and 48 cases by SPECT, it was 52.63% （ 10 cases） and 47.92% （23 cases） respectively （MEG compared with V-EEG, V-EEG plus sphenoidal electrode, PET and SPECT respectively, P 〈 0.05 ）. For the 14 cases with temporal epilepsy due to hippocampal sclerosis, only 8 （57.14%） was detected by MEG preoperatively, but 12 cases （85.71%） was found when V-EEG plus sphenoidal electrode recording was performed （P 〈 0.05）. Conclusion MEG improves the accuracy of preoperative location of epileptogenic focus in refractory epilepsy surgery; but for the patients with temporal epilepsy, V-EEG plus sphenoidal electrode recording maybe a better choice.