皮层电极监测、图像融合和术中磁共振精确镜下导航技术在切除功能区癫痫灶的应用

Application of cortical electrode,image fusion and intraoperative MRI navigation in surgical resection of epileptic lesions in functional area

目的探讨颅内皮层电极监测、图像融合和术中磁共振精确导航技术在切除功能区癫痫灶的应用价值。方法回顾分析25例应用皮层电极监测、图像融合和术中磁共振精确导航技术外科治疗的顽固性癫痫病例,第1次手术,根据动态视频脑电图监测结果,埋置颅内皮层电极与可能癫痫放电区域,术后进行皮层脑电监测、皮层电刺激定位躯体运动区,绘制病灶与功能区关系图,而后将CT、MRI、MEG或PET图像融合,在术中MRI镜下导航行致痫病灶的精确切除。结果 25例第1次术后成功实施皮层电刺激,准确定位癫痫病灶周边的运动功能区。将患者的MRI、MEG或PET图像进行融合,20例在术中MRI镜下导航将术前所确定的癫痫灶全部切除,5例因病灶与功能区有部分重叠,行癫痫灶部分切除,残余少许皮层小功率热灼。1例术后出现一过性对侧肢体功能障碍,所有患者术后无永久神经功能缺失。结论颅内皮层电极监测对癫痫灶的精确定位意义重大,而图像融合和术中MRI镜下导航为患者癫痫灶的精确切除和功能区保护提供了强有力的技术支持。

Objective To study the application of cortical electrode,image fusion and intra-operative MRI navigation in surgical resection of epileptic lesions in the functional area.Methods Application of cortical electrode,image fusion and intra-operative MRI navigation in surgical resection of epileptic lesions in 25 patients with refractory epilepsy was retrospectively analyzed.Intracranial cortical electrodes were implanted into epileptic lesions of the patients according to their VEEG during the first operation.Their cortical electrical activity was monitored,cerebral motor area was located by cortical electrical stimulation,a figure of correlation between epileptic lesion and functional area was plotted after operation,images of CT,MRI,MEG or PET were fused,and the epilepsy lesions were precisely removed under microscopic MRI navigation.Results Cortical electrical stimulation was successful in 25 epilepsy patients during the first operation and the cortical motor area around the epileptic lesion was accurately located.The images of MRI,MEG or PET for the patients were fused.Of the 25 patients,20 underwent total resection of epileptic lesion and 5 underwent partial resection of the lesion under microscopic MRI navigation due to the overlapped lesion and functional area.The residual cortex was eradicated by thermal burn.Transient opposite extremity dysfunction was observed in 1 patient after operation.No permanent neurological deficit occurred in all patients after operation.Conclusion Accurate location of intracranial cortical electrodes is of great importance for monitoring epileptic lesions.Fusion of MRI,MEG or PET images and microscopic MRI navigation during operation can provide technical support for the precise resection of epileptic lesions and protection of the functional area