PET/CT定位伽玛刀治疗顽固性癫痫的临床研究

To evaluate efficacy of the gamma knife for intractable epilepsy by PET/CT

目的评价PET/CT定位伽玛刀治疗难治性癫痫的疗效。方法对2007年1月至2010年12月来我院就诊的难治性癫痫患者进行PET/CT检查,30例患者接受了伽玛刀治疗,均以50%等剂量曲线包绕病灶,周边剂量为9～13Gy。根据PET/CT显示的致痫灶的代谢分为低代谢组(A组)和高代谢组(B组,包括高低病灶并存);低代谢组根据PET/CT显示的致痫灶的数量分为单病灶组(A1)和多病灶组(A2)。结果随访12～48个月,30例患者PET显像均表现异常,低代谢灶20例,高代谢灶8例,低代谢灶和高代谢灶共存2例。低代谢组中单病灶14例,多病灶6例。A和B组癫痫发作频率较治疗前明显降低,且B组疗效明显高于A组。A1组和A2组癫痫发作频率较治疗前明显降低,且A1组疗效明显高于A2组。所有治疗病例均未发生明显并发症。结论 PET/CT定位伽玛刀治疗难治性癫痫具有较高的有效率。高代谢组疗、单一病灶组疗效优于低代谢组、多病灶组。

Objective To evaluate efficacy of the Gamma Knife after location of intractable epilepsy by PET/CT.Methods 30 patients with refractory epilepsy patients from January 2007 to December 2010 in our hospital were performed PET / CT scan.50% radiosurgery dose was between 9~13 Gy.According to lesions metabolism that PET/CT shows and will treatment by Gamma Knife were divided into a low metabolism group（A） and high metabolic groups（B,including the coexistence of high and low lesions）;A groups according to PET/CT shows the number of epileptic foci were divided into a single lesion group（A1） and multi-site group（A2）.Results All the patients had a follow-up period of 12~48 months and observe the efficacy of Gamma Knife.PET/CT shows low metabolic foci in 20 cases,high metabolic foci in 8 cases,and both in 2 case,14 cases of single lesions,multiple lesions in 6 cases.A and B group observed seizure frequency significantly lower than that before treatment,and the effect of B group was significantly higher than A group.A1 group and the A2 group observed that seizure frequency significantly lower than that before treatment.And the effect was significantly higher than with A1 Group A2 Group.There were no significant complications in all cases.Conclusion It has a high efficiency that the patients with refractory epilepsy underwent the radiosurgery guided by PET/CT and high metabolic lesion better than low metabolic lesion and single lesion was better than multi-lesion.