颅骨钻孔硬脑膜下电极置入视频脑电监测在致灶定位中的应用

Localization of epileptogenic foci via video electroencephalography monitoring through subdural electrodes implanted by sphenotresia

目的探讨颅骨钻孔硬脑膜下电极置入视频脑电图监测定位致灶的效果、并发症及其致灶切除手术的疗效。方法回顾性分析2006-11至2013-10火箭军总医院65例颅骨钻孔硬脑膜下电极置入视频脑电图监测定位致灶的病例资料。结果明确定位致灶65例(100%)。出现并发症1例(1. 54%),为局部脑组织挫伤。死亡1例(1. 54%)。65例全部施行了致灶切除性手术,或切除性手术+阻断癫放电传播性手术。术后平均随访期(24. 8±10. 5)个月。根据Engel手术效果分级,Ⅰ级40例(61. 54%),Ⅱ级9例(13. 85%),Ⅲ级12例(18. 46%),Ⅳ级4例(6. 15%),发作控制良好(Ⅰ+Ⅱ级)的共49例(75. 38%),手术疗效良好。结论颅骨钻孔硬脑膜下电极置入视频脑电图监测致灶定位效果良好,安全性高,出现永久性神经功能障碍的可能小,病死率低,该方法定位致灶后,致灶切除手术效果良好。

Objective To investigate the outcome and complications of localization of epileptogenic foci via video electroencephalography monitoring through the subdural electrodes implanted by sphenotresia. Methods The data on 65 intractable epilepsy patients who underwent the implantation of subdural electrodes by sphenotresia and video electroencephalography monitoring between November 2006 and October 2013 was reviewed and analyzed. Results Sixty-five cases of epileptogenic foci were identified,so the localization rate was 100%( 65/65). One case of complications occurred,which was focal brain contusion and laceration,so the rate of complications was 1. 54%. One patient died,and the mortality rate was 1. 54%. There were no severe and permanent neurological complications in any of the patients. All the 65 cases underwent resection of epileptogenic foci. The mean postoperative follow-up was( 24. 8 ± 10. 5) months. According to the Engel classification on surgical outcomes,the surgical outcomes were as follows: Engel Ⅰ,n = 40,61. 54%;Engel Ⅱ,n = 9,13. 85%;Engel Ⅲ,12,18. 46%;Engel Ⅳ,n = 4,6. 15%. Good seizure control( Engel classⅠ and Ⅱ) was obtained in 49( 75. 38%) patients. Conclusions The effect of localization of epileptogenic foci via video electroencephalography monitoring through the subdural electrodes implanted by sphenotresia is significant. This approach is safe and feasible.The result of resection of epileptogenic foci localized by this method is good.