联合应用Co-SEP、MEP和ECoG监测指导功能区继发性癫痫手术

Combination of Co-SEP,MEP and ECoG used in monitoring surgical therapy of secondary epilepsy of eloquent cortex lesions

目的:探讨联合应用诱发电位和皮层脑电监测技术对功能区继发性癫痫外科手术的指导作用。方法:对14例中央区病变的继发性癫痫患者在术中行皮层体感诱发电位(Co-SEP)及皮层电刺激运动诱发电位(MEP)检查以定位脑功能区;皮层脑电图(ECoG)监测界定致痫灶皮层区域。结果:14例均通过Co-SEP位相倒置界定中央沟位置,并电刺激中央前回,分别于口轮匝肌、大鱼际肌、小鱼际肌及趾短屈肌处引出MEP,以此指导的手术在切除病变及致痫组织时避开中央区的损害;并在ECoG监测下指导病灶周围致痫区皮层的手术治疗。术后观察1～2周,患者癫痫发作均较前明显减少或消失;2/14例(14.29%)术后出现一过性失语或肢体无力,余病例无神经功能障碍。结论:术中联合应用Co-SEP、MEP和ECoG监测指导重要脑功能区继发性癫痫手术是安全有效的,可为手术提供成功的保障。

Objective： To explore the combination of cortical evoked potentials and EEG monitoring technology used in the secondary epilepsy surgery on the eloquent cortex. Methods： In 14 cases with secondary epilepsy on the central area, intraoperative cortical somatosensory evoked potentials （Co-SEP） and cortical electrical stimulation motor evoked potential （MEP） were performed to locate central area. Cortical EEG monitoring （ECoG） were carried out to confirmed the epileptogenic zone. Results： The central sulcus was confirmed by Co-SEP in 14 cases. Stimulated the preeentral gyrus, MEP were elicited from orbieularis oris , muscle of thenar, hypothenar muscle or flexor digitorum brevis, so as to prevent dyskinesia . The results were observed for 1 -2 weeks after surgery. Seizures in all cases were reduced or disappeared. 2/14（14.29%） cases were undergone transient motor aphasia incompletely or a brief decline in physical strength eontralateral limbs. The remaining were well. Conclusion： Combination of Co-SEP, MEP and ECoG are safe and effective for secondary epilepsy surgery.