视频脑电图在四脑室肿瘤术后早期癫痫发作诊断中的应用价值

Diagnostic value of video-electroencephalograph monitoring on early postoperative seizures after fourth ventricular tumor resection

目的探讨四脑室肿瘤手术前后脑电的变化特点,为诊断或鉴别诊断该类肿瘤所致的术后早期癫痫提供电生理依据。方法回顾性分析我科2009年1月至2011年12月收治的23例四脑室肿瘤患者手术前后的脑电及临床特征。结果 23例患者术前伴有不同程度脑积水,均无癫痫发作史,术前脑电显示:9例正常、8例散在性慢波增多、6例见阵发性节律性慢波。术后脑积水均得到缓解。围术期脑电显示:16例患者背景慢化,频率较术前减慢;3例患者背景慢化伴散在出现单个负向尖波/尖慢波,持续观察临床无癫痫发作;4例患者同步化节律性慢波+间歇性全脑暴发痫样放电,其中1例视频观察到有眼睑抽搐,3例虽无明显临床发作,但均表现为不同程度意识障碍,后经抗癫痫治疗,意识改善明显。结论四脑室肿瘤术后行视频脑电监测有助于诊断或鉴别诊断术后早期癫痫发作,特别是不典型的癫痫发作类型。

Objective To explore the changes of preoperative and postoperative electroencephalograms of video-electroencephalography （V-EEG） in monitoring fourth ventricular tumor resection in order to found an electrophysiological basis to diagnose or differential diagnose early postoperative epilepsy caused by fourth ventricular tumor. Methods Preoperative and postoperative EEG and clinical characteristics of 23 patients with fourth ventricular tumor in our hospital from Jan. 2009 to Dec. 2011 were retrospectively analyzed. Results These 23 patients all had hydrocephalus at various degrees but no history of seizures before surgery. Preoperative EEG displayed there were 9 patients of normal EEG, 8 of increased sporadic slow waves in all electrodes, and 6 of paroxysmal rhythmic slow waves. Hydrocephalus was obviously alleviated after surgery. Perioperative EEG indicated that 16 patients with background moderation and slower EEG frequencies, 3 patients with background moderation, synchronous rhythmic slow wave and sporadic single suspicious negative sharp wave/sharp slow wave but with no epileptic seizure after continuous observation, 4 patients with synchro- nous rhythmic slow wave and sporadic bursts of spike/multi-spike slow waves, and 1 patient with eyelid twitc- hing and 3 patients without obvious clinical seizures, but with various disturbance of consciousness observed by video. Consciousness improved significantly after antiepileptic treatment. Conclusion V-EEG monitoring is useful to diagnose or differential diagnose early postoperative epilepsy, especially non-typical seizures.