颅内电极监测的额叶癫痫外科治疗

The surgery of lobe epilepsy monitored by intracranial electrode

目的探讨颅内电极监测对额叶癫痫手术治疗的指导作用,总结额叶癫痫手术治疗效果。方法从2007年3月至2012年3月对我科40例额叶癫痫患者,采用颅内电极监测定位致痫灶和功能区,二次手术进行致痫灶处理。术后对患者进行1年到6年随访,对手术疗效进行改良ENGEL分级。结果本组男性25例,女性15例;患者年龄最小为6岁,最大为50岁,平均24.1岁;所有患者均成功行颅内电极植入,其中单侧28例,双侧12例。所有患者均通过颅内电极监测到致痫灶,其中16例致痫灶涉及功能区。对40例患者均行额叶致痫灶切除,并对5例行部分颞叶处理,9例行胼胝体切开,16例致痫灶涉及功能区者行皮层电热灼。电极植入术后,1例患者发生硬膜下血肿,约50ml,进行血肿清除后成功监测并进行致痫灶手术处理,1例致痫灶处理术后发生头皮延迟愈合,经清创术后1月愈合。对术后患者疗效行1年到6年时间随访,按照改良ENGEL分级显示Ⅰ级23例,占57.5%;Ⅱ级7例,占17.5%;Ⅲ级8例,占20%;Ⅳ级2例,占5%;Ⅰ级和Ⅱ级患者占总体75%,说明手术疗效良好者占比例高。结论颅内电极对额叶癫痫致痫灶和功能区准确定位是额叶癫痫手术治疗取得成功的关键。

Objective To explore the guiding role of intracranial electrode monitoring in frontal lobe epilepsy surgery, to summarize the efficacy of frontal lobe epilepsy surgery. Methods From March 2007 to March 2012,40 patients with frontal lobe epilepsy had underwent intracranial electrode monitoring and secondary surgical treatment. The location of epileptic foci and functional areas were accurately determined. We evaluated the result with modified ENGEL classification after 1-6 yearg follow--up. Results This group enrolled 15 femals,25 males- 6 -50 years old,average age was 24. 1 years old; All patients were successfully took intracranial electrode implantation,28 cases were unilateral, the other were bilateral; All patients was found with epileptic loci by imracranial EEG monitoring successfully,in which 16 patients＂ epi- leptic loci involved functional areas; all patients underwent resection, 5 cases took tailored temporal lobe resection,9 cases took corpus callosotomy, 16 cases involved functional areas were underwent cortical electric burning. Subdural hematoma grew in one patient,the volume was approximately 50ml,and we successfully monitored the epileptic foci after clearance of the hematoma, one patient＇s scalp delayed healing and went to heal after debridement in one month. We evaluated the result with modified ENGEL classification after 1-- 6 years＇ follow--up,23 cases attained grade I,accounting for 57. 5%; 7 cases reached grade II,accounting for 17. 5 %, 8 cases achieved grade HI,accounting for 20%, 2 cases accorded with grade IV, 50%. Conclusion Accurate positioning of epileptic foci and functional areas of frontal lobe epilepsy by intracranial electrode monitoring is the key to the success of frontal lobe epilepsy surgery