非侵袭性检查定位致痫灶在癫痫外科治疗中的作用

Evaluation of noninvasive protocol in the localization of epileptic foci for surgical treatment

目的评价非侵袭性检查方法定位致痫灶在癫痫外科治疗中的作用。方法对30例难治性癫痫病人行EEG、MRI、PET检查,根据3项检查结果选择外科治疗方法(开颅手术,X-刀治疗,立体定向手术)。开颅手术者,术中行皮层脑电图(ECoG)检查。结果致痫灶位于颞叶22例,颞叶外6例,额颞区2例。方法开颅手术16例,X-刀治疗10例,立体定向手术4例。术后除2例发作无明显改善外,28例病人发作均明显减少或消失。结论大部分难治性癫痫病人,尤其是颞叶癫痫,开颅致痫灶切除、放射外科、立体定向手术可以根据EEG、MRI、PET检查来定位,避免术前侵袭性EEG(如植入深部电极等)检查的危险性。

Objective To evaluate the value of the noninvasive methods localizing epileptic foci for surgical treatment.Method30patients with intractable epilepsy received the examination of EEG,MRI,18 F-FDG PET,and underwent surgical treatment (treated after craniotomy,X-knife,stereotactic operation)according to the results of examination.Resutl22of the patients had temporal,6had extratemporal and2had frontal-temporal epilepsies.All patients were treated according to the noninvasive localization method,16patients were treated by craniotomy,10by X-knife and4by stereotactic operation.Only2patients remained seizure as before,the others were completely or mostly had seizure free.Conclusion In a considerable number of patients with intractable temporal focal epilepsy,resective surgery,X-knife and stereotactic operation can be based on noninvasive methods.The risk of invasive EEG monitoring can be avoided.