颅内电极监测技术在癫痫手术中的应用

Application of Electroencephalogram Recorded by Intracranial Electrode to Epilepsy Surgery

目的探讨颅内电极监测技术在难治性癫痫外科治疗中的应用价值。方法对头皮脑电图及影像学等非侵袭性检查难以确定致痫灶或致痫灶与重要功能区关系密切的51例难治性癫痫患者,行颅内电极埋置术,长程视频脑电图监测确定致痫灶,并行脑皮层电刺激功能区测定,再次手术切除致痫灶。结果术后致痫灶切除效果按Engel分级:Ⅰ级32例,Ⅱ级13例,Ⅲ级5例,Ⅳ级1例。术后发生头皮愈合不良3例,延长住院时间后治愈。无脑脊液漏及永久性神经功能缺失发生。结论颅内电极监测可以精确定位致痫灶,皮层电刺激术对脑功能区定位可靠、方便,故对于采用非侵袭性检查不能明确致痫灶或致痫灶与重要功能区关系密切的难治性癫痫患者,颅内电极监测结合皮层电刺激术可以提高其治愈率,并有效降低并发症发生率。

Objective To investigate the value of application of electroencephalogram （EEG） recorded by intracranial electrode to surgery for intractable epilepsy. Methods The epileptogenic zones were resected after they were localized by the long-term video EEG recorded with the electrode implanted into the cerebral areas and the relationship between the epileptogenic zones and important function areas was determined by the electrical stimulation of the cerebral cortexes in 51 patients with intractable epilepsy, in whom the epileptogenic zones could not be determined by preoperative noninvasive examinations including scalp EEG, MRI and so on or the epileptogenic zones were close to the important function cortexes. Results Of 51 patients with intractable epilepsy, 32 were seizure free, 13 improved significantly in seizure, 5 improved in seizure, and 1 unimproved in seizure after the surgery. The healing of the wound on the scalps was delayed in 3 patients. There was no permanent neurological defect in all the patients. Conclusions The epileptogenic zone may be precisely localized by intracranial EEG and the important function cortex may be reliably and conveniently localized by electrical stimulation. The intracranial EEG combined with electrical stimulation of the cortex can enhance the curative effect and decrease complication rate in the patients with intractable epilepsy in whom the epileptogenic zones can not be determined by the noninvasive examination or the epileptogenic zones are close to the important function cortexes.