颅内电极长程记录在颞叶癫痫定位中的应用

Application of intracranial electrode for locating epileptogenic zone for temporal lobe epilepsy surgery

目的探讨颅内电极长程记录在颞叶癫痫定位、定侧中的应用，评价其临床价值。方法2006年1月至2010年10月北京天坛医院神经外科60例经颅内电极定位的颞叶癫痫患者，电极类型采用硬膜下条状、栅状以及深部电极，手术方式包括颅骨钻孔电极植入、立体定向深部电极植入和骨瓣开颅电极植入。结果额-颞皮层电极植入34例，额-颞前-颞枕交界电极植入7例，双颞皮层电极植入7例，深部电极联合颞叶皮层电极植入7例，颞前-颞枕交界电极植入3例，条状电极联合栅状电极植入2例。手术方式包括前颞叶切除术50例，联合额叶致痫灶切除7例，联合胼胝体切开1例，颞后枕新皮层痫灶切除联合海马杏仁核切除2例。结论颅内电极长程记录是一种有效的检查方法和重要的定位手段，可应用于无创评估方法难以定位、定侧的颞叶癫痫。

Objective To explore the application of intracranial electrodes （IE） for temporal lobe epilepsy （TLE） surgery and assess the clinical utility of intracranial video electroencephalography （IVEEG）. Methods The clinical data of 60 TLE patients undergoing implantation of IE were reviewed retrospectively. Cortical subdural strip, grids and depth electrodes were implanted by sphenotresia, bone disc craniotomy or stereotactic technology. Results The implanted electrodes were as follows： frontal- temporal lobe cortical strip （n = 34）, frontal-anterior temporal-occipitotemporal lobe cortical strip （n = 7 ）, bilateral temporal lobe cortical strip （ n = 7 ） , combined temporal lobe strip ＆ depth （ n = 7 ） , anterior temporal-occipitotemporal junction cortical strip （ n = 3 ） and combined strip ＆ grid （ n = 2）. The following procedures were performed： anterior temporal lobectomy （ATL） （ n -- 50）, combined ATL ＆ frontal focal cortical resection （ n = 7 ）, combined ATL ＆ callosotomy （ n = 1 ） and combined neocortex epileptogenic focus resection ＆ amygdalohippocampectomy （n = 2 ）. Conclusion IVEEG is effective and important for the localization of epileptogenie focus in patients with intractable temporal lobe epilepsy.