皮质电极监测在致痫性蛛网膜囊肿手术中的应用

APPLICATION OF CORTICAL ELECTRODE MONITORING IN SURGERY FOR EPILEPTOGENIC ARACHNOID CYSTS

目的探讨术中皮质电极监测在致痫性蛛网膜囊肿手术治疗中的应用价值。方法蛛网膜囊肿病人19例,术前均有癫痫发作史,CT或MRI检查确诊。术前常规脑电图检查正常3例,轻度异常8例,中度异常6例,重度异常2例。常规开颅行蛛网膜囊壁全部或部分切除,同时行皮质电极监测,根据癫痫波位置行致痫灶切除或软膜下横切术。结果 19例病人术中皮质电极均监测到癫痫波,其中12例行致痫灶切除术,4例行多处软膜下横切术,3例行多处软膜下横切并颞极、海马切除术。术后常规脑电图检查均未见癫痫波。随访6个月～4年,18例癫痫消失;1例发作明显减少,口服药物可控制。结论在致痫性蛛网膜囊肿病人手术中,使用皮质电极监测致痫灶,定位准确,灵敏度高。

Objective To evaluate the value of cortical electrode monitoring（CEM） in surgery for epileptogenic intracranial arachnoid cysts（EIAC）. Methods Nineteen patients with EIAC,who had a preoperative history of seizure disorder,were confirmed by CT or MRI.A preoperative EEG showed normal in three cases,slightly abnormal in eight,moderately abnormal in six and severely abnormal in two.The cysts were totally or partially resected through craniotomy,and,at the same time,CEM was conducted,the epileptogenic foci were removed or subpial transections performed according to the location of the epilepsy wave. Results Epilepsy wave was detected in all the patients during surgery.Of the 19 patients,a lumpectomy was done in 12 cases,multiple subpial transection in four,and multiple subpial transaction plus anterior temporal lobectomy and hippocampectomy in three.A postoperative EEG showed no epilepsy waves were found.A follow-up of from six months to four years indicated that 18 cases were epilepsy-free,and one experienced obvious decrease of seizures that could be controlled by oral medication. Conclusion In surgical therapy for EIAC,the use of cortical electrode monitoring can accurately and sensitively locate the epileptogenic foci during operation.