立体定向放射外科治疗功能区顽固性癫的研究

Stereotactic radiosurgery for refractory epilepsy in the eloquent brain area

目的评价立体定向放射外科在功能区顽固性癫疒间的治疗作用。方法回顾性分析功能区顽固性癫疒间85例。根据癫疒间发作特点、脑电图及影像学检查综合评估和定位。采用Brainscan X-刀治疗系统实施治疗,中心剂量12~16 Gy,周边剂量9~13 Gy。随访3~118个月,平均70个月。结果脑电图改变在术后12个月达到高峰,28.6%恢复正常,46.8%明显好转;发作频率在术后6个月明显降低,24个月降低达治疗谷峰;疗效在术后24个月达到高峰,有效率89.1%。术后影像学检查显示放射性脑水肿59例,其中出现症状需处理6例,经治疗后均恢复;短期内一过性癫疒间发作频率升高8例,无致残和死亡病例。结论立体定向放射外科治疗功能区顽固性癫疒间效果良好,可作为无法手术病人的替代治疗方法。

Objective To evaluate the role of stereotactic radiosurgery in treatment of refractory epilepsy in the eloquent brain area.Methods Clinical data of 85 patients with refractory epilepsy in the eloquent brain area were analyzed retrospectively.The epileptogenic focus was determined based on characteristics of seizure,electroencephalogram（EEG） and imaging examinations.Brainscan X-knife system was used in all the patients with central dose of 12 to 16 Gy and marginal dose of 9 to 13 Gy.The patients were followed up for mean period of 70 months,ranged from 3 to 118 months.Results The EEG changes reached the peak 12 months after surgery,28.6% of the patients recovered to normal and 46.8% improved significantly.Seizure frequency decreased obviously 6 months after the surgery,and reaches the lowest value 24 months after the surgery.The therapeutic effect reached the peak 24 months after surgery,and the efficacy rate was 89.1%.Radiation-induced cerebral edema was found by imaging examinations in 59 cases,of which 6 cases developed symptoms and required treatment,and all the patients recovered after treatment.Seizure frequency increased transitorily in 8 cases,and no disability and death cases occurred.Conclusions Stereotactic radiosurgery can obtain a satisfactory effect for refractory epilepsy in the eloquent brain area,and can be used as an alternative method for inoperable patients.