颅内电极监测在儿童额叶癫痫手术中的应用

Application of Intracranial Electrode in the Surgery for Children with Drug-resistant Frontal Epilepsy

探讨颅内电极监测在磁共振(MRI)诊断阴性难治性儿童额叶癫痫手术中的应用。回顾性分析2006年6月至2008年8月期间清华大学玉泉医院癫痫中心科收治的40例儿童额叶癫痫病例。根据患儿发作的症状及头皮脑电图特点,对可疑的癫痫灶起源区植入颅内电极,行皮层脑电图(ECoG)监测,定位癫痫灶及功能区。结果显示,40例中单纯前额叶切除12例,前额叶切除加局限性皮层切除或/及皮层热灼8例,局限性皮层切除加皮层热灼7例,前额叶外侧切除加局限性皮层切除或/及皮层热灼7例,前额叶内侧切除加局限性皮层切除或/及皮层热灼6例(其中3例加胼胝体切开)。无手术死亡率和严重并发症。随访20个月到36个月,手术后疗效按Wilson标准评判,优良率为80%,其中8例(20%)癫痫发作完全消失;14例(35%)癫痫发作次数显著减少;10例(25%)癫痫发作程度减轻;8例(20%)无明显改善。由此得出结论:应用颅内电极进行精确致痫灶和功能区定位后,制定个体化治疗计划,选择前额叶切除、局限性皮层切除、皮层热灼、胼胝体切开,或根据需要联合两种或多种术式是治疗MRI阴性难治性儿童额叶癫痫的有效方法。

The application of intracranial electrode in the surgery for children with drug-resistant frontal epilepsy with negative MRI is discussed. Retrospective analysis is conducted of 40 cases of children patients in the surgery treatment for drug-resistant frontal epilepsy in our ward between June 2006 and August 2008. Considering the children＇s seizure manifestations and scalp video electroncephalogram, the intracranial electrode is planted in suspected epileptogenic zones, then based on ECoG and/or cortical stimulation, the real epileptogenic zones are identified. All the patients received surgery treatments to remove epileptogenic zones. The frontal epilepsy was confirmed for all patients. Frontal lobectomy was performed on 12 cases, frontal lobectomy combined with local epileptogenic cortex resection and/or bipolar coagulation of the codex was performed on 8 cases, local epileptogenic cortex resection and/or bipolar coagulation of the codex was performed on 7 cases. Lateral frontal lobectomy combined with local epileptogenic cortex resection and/or bipolar coagulation of the codex was performed on 7 cases. Medial frontal lobectomy combined with local epileptogenic cortex resection and/or bipolar coagulation of the codex was performed on 6 cases （with 3 cases of additional corpus callostomy）. There were no severe complication mortality. Patients were followed up for 20 to 36 months. The curative effects were analyzed with Wilson standard in postop, with fineness rate of 80%, 8 cases （20%） were free from seizure, a significant reduction of seizure attack was found in 14 cases （35%）, 10 cases （25%） saw a reduction of seizure attack, no change was observed in 8 cases （20%）. Therefore, the children frontal epilepsy can be well treated by epileptogenic zones resection, corpus callostomy, bipolar coagulation and frontal lobectomy or by 2 and more methods combined after a precise identification of the epileptogenic zone.