电生理监测结合神经导航手术治疗灰质异位症所致癫痫

Application of electrocorticography and neuronavigation in the surgical treatment of patients with refractory epilepsy caused by Gray Matter Heterotopia

目的探讨电生理监测结合神经导航技术在灰质异位症所致癫痫外科手术中的应用价值。方法回顾性分析1999年3月到2009年1月11例灰质异位症所致难治性癫痫手术病例,其中7例单纯灰质异位症,4例分别合并脑沟裂畸形、海马硬化、胼胝体发育不良伴蛛网膜囊肿、透明隔囊肿。术前常规行长程脑电图监测并行磁共振导航序列扫描,将图像传输至导航工作站(ASA-610V式BrainLAB导航系统)。术中在导航引导下切除异位灰质组织,切除前后行皮层脑电描记(Nation 9200式Bio-logic脑电描记系统),根据脑电监测情况选择合并畸形的处理方式及是否辅以小灶皮层切除术和/或皮层热灼术。结果随访13～56个月。根据Engel疗效分级评估:Ⅰ级3例,Ⅱ级7例,Ⅲ级1例。无永久性并发症和死亡发生。结论神经导航结合术中电生理监测手术治疗灰质异位症所致难治性癫痫,手术定位准确,侵袭性小,在切除致癫性病灶同时能最大限度的保护神经功能,疗效确切。

Objective To investigate the value of neuronavigation and electrocorticography for refractory epilepsy surgery in patients with gray matter heterotopia（GMH）.Methods 11 patients with refractory epilepsy caused by GMH operated from March 1999 to January 2009 were analyzed retrospectively,7 patients of which were simple GMH,and 4 patients combined other malformations： brain groove cleft malformation,corpus callosum hypoplasia and arachnoid cyst,hippocampal sclerosis,septum pellucidum cyst.Before operation,all the patients underwent long-term EEG and MRI navigation sequence scanning,the images were transferred to navigation workstation（ASA-610V and BrainLAB navigation system）.Heterotopic gray matter organizations were resected in the navigation-guided surgery,before and after the removal of the lesion electroencephalography（Nation 9200 and Bio-logic electroencephalography system） was used to mark the epileptogenic foci.According to EEG monitor to decide how to treat the joint deformity,and whether the treatment bipolar coagulation and/or removal of the special cortex was to supplemented.Results The series of patients were followed up for 13～56 months.According to Engel＇s class： grade Ⅰ in 3 cases,grade Ⅱ in 7 cases,grade Ⅲ in 1 case.There were no permanent complications or death.Conclusion The combination of intraoperative neuronavigation and electrophysiological monitoring for treatment of intractable epilepsy caused by heterotopic gray matter is minimally invasive and accurate localization for remove epileptic foci,could be able to pretect cerebral functions maximum and reach definitely efficacy.