癫痫外科颅内电极埋置方法、风险及对策

Methods and risk countermeasures of the intracranial electrode implantation in epilepsy surgery

目的：探讨癫痫外科长期描记的颅内电极埋置手术方法及并发症的处理，提高手术的安全性与成功率。方法：回顾性分析2007年1月至2012年12月接受癫痫手术的403例患者行颅内电极埋置的经验，总结其适应证、操作方法、并发症及应对措施。结果：403例患者接受了408次颅内电极埋置手术，其中5例（i．2％）患者因电极覆盖范围不足而接受了第二次电极埋置术，平均监测时间3．7d（2～21d）。手术风险包括：术后颅内血肿29例（7．2％），脑水肿5例（1．2％），脑脊液漏11例（2．7％），术口感染13例（3．2％），颅骨骨髓炎5例（1．2％），电极折断1例（0．2％）。没有因颅内电极埋置术而引起严重神经功能缺失和死亡者。结论：颅内电极埋置长程皮质脑电监测术是癫痫外科一项相对安全的侵袭性检查方法。术前完善无创性检查措施，合理制定手术方案，注意操作细节及技巧，可避免并发症的发生。

Objectiw：To better define the methods and risk countermeasures of the intracranial e- lectrode implantation in epdepsy surgery. Methods：Experience in 403 patients with intracranial electrode implantation between January 2007 and December 2012 for long-term invasive EEG monitoring and func- tional mapping before epilepsy surgery was reviewed retrospectively. The indications, methods, compli- cations and risk countermeasures of the electrode implantation were analyzed. Results： 408 implantation procedures were operated in 403 patients. The mean monitoring period was 3.7 days （range 2-21 days）. Operative risks included the need for repeated surgery for additional electrode placement in 5 cases （ 1.2 % ）, postoperative intracranial hematoma in 29 eases （7.2% ）, brain edema in 5 （ 1.2 % ）, eerebrospi- nal fluid leak in 11 （2.7%） , wound infection in 13 （3.2%）, hone flap osteomyelitis in 5 （1.2%） and strip electrode fracture in 1 （0.2 %）. There were no permanent deficit or death associated with invasive monitoring. Conclusion： Intracranial electrode implantation for long-term invasive EEG monitoring is a relatively safe invasive procedure. The plan of the electrode implantation must be carefully made accord- ing to the results of noninvasive presurgical evaluation, besides, great attention should be paid to some cautions and operative skills.