蝶骨电极长程视频脑电在癫痫手术定位中的应用

The analysis for application of continual sphenoidal electrodes video electroencephalogram in epileptic surgery

目的探讨蝶骨电极长程视频脑电在癫痫手术定位中的应用意义。方法对117例难治性癫痫进行带蝶骨电极的长程视频脑电监测,结合磁共振成像(MRI)及发作间期正电子发射计算断层扫描(PET)检测结果进行癫痫灶定位,其中手术治疗83例,包括44例颞叶内侧面癫痫、39例非颞叶内侧面癫痫,其余34例不能确定癫痫起源部位而未手术。对该117例长程视频脑电图监测结果进行回顾分析,并对39例非颞叶内侧面癫痫长程视频脑电与术中记录的皮层脑电(ECoG)进行比较。结果44例颞叶内侧面癫痫、39例非颞叶内侧面癫痫及34例未手术患者蝶骨电极发作间期的棘波、棘慢波、尖波、尖慢波总检出率分别为86.4%、20%和29.4%,前者与后两者之间均相差显著(P<0.005),蝶骨电极脑电定侧率为(31/44)70.5%,显示了术前蝶骨电极长程视频脑电图定位准确率较高,39例非颞叶内侧面癫痫术中皮层脑电于术前定位的相应部位均检测到棘波;44例颞叶内侧面癫痫均行一侧前颞叶及海马杏仁核切除术,39例非颞叶内侧面癫痫行相应皮质区切除等。结论蝶骨电极长程视频脑电对颞叶内侧面痫样放电的检出率高,且定侧准确率较高;蝶骨电极长程视频脑电能有效鉴别诊断颞叶内侧面癫痫与非颞叶内侧面癫痫。总之,加用蝶骨电极的长程视频脑电定位信息较为全面,有助于准确定位,提高手术疗效,可作为癫痫外科的常规检测。

Objective To investigate the applied significance of sphenoidal electrodes long term video electroencephalogram monitoring in surgical treatment of EP（epilepsy）.Methods Long term VEEG monitoring with sphenoidal electrodes was used on 117 intractable epilepsy patients.Combined with the detected result of MRI and PET,to locate epileptogenic focis.83 cases were treated with operation,there are 44 cases MTLE（medial temporal lobe epilepsy）and 39 cases neocortical epilepsy.To analyse the result of sphenoidal electrodes long term VEEG monitoring of 117 cases,VEEG monitoring of 39 cases neocortical epilepsy were also compared with their ECoG monitoring in operations.Results The detectable rate of epileptic discharge was 86.4 % in 44 cases MTLE、20% in 39 cases neocortical epilepsy and 29.4% in the rest 34 cases by continual sphenoidal electrodes monitoring during interictal period,it showed significant difference between the preceding group and two latter goups（P〈0.005）;the side of epileptogenic foci determined by sphenoidal electrodes achieved a rate as（31/44）70.5% in 44 cases MTLE,and pre-temporal lob 、hippocampal and corpus amygdaloideum were all removed;epileptic discharges were obtained from predicated localization of epileptogenic foci in all 39 neocortical patients by ECoG monitoring in operations,the precision of localization of epileptogenic pre-operation was proved,39 cases were treated by fit ways of surgery.Conclusion Continual sphenoidal electrodes monitoring has a high detectable rate of epileptic discharge and a high accuracy rate of localization to MTLE;it can differentiate MTLE and neocortical epilepsy effective as well.To sum up,Continual sphenoidal electrodes monitoring can supply full information for helping localization of epileptogenic foci accurately and advancing a favorable curative effect after operation,it should be applied to epileptic surgery as a commonly examination.