立体定位脑电图对额叶癫痫的定位价值

To locate the epileptogenic zones by the stereo-electro-encephalography in patients with frontal lobe with epilepsy

目的：探讨立体定位脑电图视频监测对需要开颅手术处理痂灶的顽固性额叶癫痫患者的定位作用。方法：通过对5例额叶药物难治性癫痫但定侧定位困难的患者，向颅内可疑部位用立体定向技术置人深部电极（1～4根，平均3根），进行视频脑电图监测，记录发作问期及发作期脑电图变化，确定癫痫发作起始区，通过手术处理致痫灶。结果：本组5例监测时间为1～7d，平均2．6d，均能记录到发作间期痢样放电及发作期脑电图情况。在术中皮层电极引导下，对额叶致痫灶进行切除，附加胼胝体切开术、扣带回切开术、软脑膜下横纤维切断术或皮层热灼术。术后按照Engel分级，Ⅰ级4例，Ⅲ级1例，5例患者均未出现置入电极和手术并发症。结论：在致痫灶定位困难的顽固性额叶癫痫患者中，采用少量深部电极构成的立体定位脑电图视频监测，可以定位致痫灶，从而提高癫痫的治愈率。

Objective：To investigate the effect of the stereo-electro-encephalography （SEEG） with a few depth electrodes in patients with intractable frontal lobe epilepsy （FLE） for the epileptogenie zones. Methods： 5 patients with intractable FLE underwent video SEEG monitoring by implantation of 1 -4 depth electrodes by （mean=3）by stereotactic method. The SEEG changes during the onset or in the interval were recorded to locate the epileptogenic zones, All of the epileptogenic zones were resected. Re- suits：The SEEG recording detected the epileptogenic zones within 1 - 7 d（mean= 2.6 d）after electrode implantation. Interietal and ictal SEEG were recorded in all patients, and electrocorticography were obtained during resecting operations with corpus callosotomy, cingulotomy, multiple subpial transection or bipolar electro-coagulation. The surgical outcomes included 4 cases of Engel class Ⅰ and 1 case of Engel class Ⅲ. No complication occurred due to the electrodes implantation or the resecting operations. Conclusion： For the intractable FLE with difficulty in location of seizure foci,the SEEG video monitoring with a few depth electrodes stereotaetic methods would make it possible to accurately locate epileptogenic zones and raise the cure rate of epilepsy.