脑灌注显像定位致痫灶与皮层脑电图、术中和病理所见比较

Preoperative localization of epileptic foci with SPECT brain perfusion imaging,electrocorticography,surgery and pathology

目的 探讨SPECT脑灌注显像定位致痫灶的价值。方法 选择拟手术治疗的药物难治性部分性癫痫和其他癫痫患者 2 3例 ,在发作间期和发作期分别进行SPECT脑灌注显像 ,用皮层脑电图 (EcoG)、手术和术后病理检查进行验证。结果 用EcoG探查SPECT显示病灶区 ,2 3例皆存在典型的尖慢波和棘尖波发放 ,发作期的局灶性放射性增高区和EcoG所示的异常电活动范围更匹配。痫波起源于相应区域的大脑皮层 ,而不是增厚和粘连蛛网膜或肿瘤本身。结论 SPECT脑灌注显像有助于识别致痫灶的位置、大小、血运和功能状态 ,对术前制定治疗方案有一定的指导作用。

Objective The value of preoperative localization of epileptic foci with SPECT brain perfusion imaging was investigated. Methods The study population consisted of 23 patients with intractable partial seizures which was difficult to control with anticonvulsant for long period. In order to preoperatively locate the epileptic foci, double SPECT brain perfusion imaging was performed during interictal and ictal stage. The foci were confirmed with electrocorticography (EcoG), surgery and pathology. Results We checked with EcoG the foci shown by SPECT, 23 patients had all typical spike discharge. The regions of radioactivity increase in ictal matched with the abnormal electrical activity areas that EcoG showed. The spike wave orginated in the corresponding cerebrum cortex instead of hyperplastic and adherent arachnoid or tumor itself. Conclusions SPECT brain perfusion imaging contributes to distinguishing location, size, perfusion and functioning of epileptogenic foci, and has some directive function on to making out a treatment programme at preoperation.