癫痫中多致痫灶放射外科处理的临床研究

Clinical research about multipel epileptic foci on the radiosurgery for intractable epilepsy

目的 探讨放射外科治疗顽固性癫痫中放射靶区确定的方法 ,尤其是针对多致痫灶的情况。方法 69例PET显像提示多致痫灶的病人 ,行直线加速器放射外科治疗 ,按靶区设定的不同分为两组。A组 ,2 1例 ,靶区为PET提示的致痫灶 ;B组 ,48例 ,靶区包括PET提示的致痫灶和可疑致痫灶。随访 3～ 1 6个月 ,观察两组病例在不同随访时间点的癫痫发作频率变化和治疗效果评价。结果 两组病例在三个时间点上均观察到癫痫发作频率较前明显降低 ,两组之间比较亦有显著差别 ,B组的发作频率明显低于A组。两组病例间癫痫控制疗效的比较亦有明显差异。疗效Ⅰ—Ⅱ级病人的比例 ,B组 (48.6 % )高于A组 (33 .3 % ) ;疗效Ⅴ—Ⅵ级病人的比例 ,A组 (2 2 .2 % )高于B组 (1 4 .3 % )。所有病例未见明显并发症发生。结论 PET引导放射外科治疗顽固性癫痫 ,具有较高的有效率 ,无明显并发症发生 ;PET显像所提示的全部致痫灶中有假阳性情况存在 ,但难以鉴别。在遇到此情况时 ,放射外科靶区应包括PET提示的所有病灶 。

Objective To explore the method of outlining target of radiosurgery for intractable epilepsy,especially for the patients with multiple epileptic foci.Methods 69 patients with multiple epileptic foci localized by PET imaging were treated by stereotactic linear accelerators based radiosurgery and divided into two groups based on the different target(Group A, 21 cases,target include only all obvious foci;Group B,48 cases,targer include all obvious and doubtful foci).All the patients had a follow-up period of 3-16 months.The frequency of seizure after surgery and the surgical outcome were evaluated.Results The seizure frequency decreased postoperatively on both groups and there was obvious statistical significant relationship between A and B.The frequency of B decreased more than A.According to Wieser's classification of operative effect,In group A,33.3% was classified as grade 1 or 2,22.2% as grade 5 or 6, In group B,48.6% was classified as grade 1 or 2, 14.3% as grade 5 or 6.The surgical outcome of group B was better than group A.There were no severe complications,no disability and mortality.Conclusions It's safe and significant effect that the patients with intractable epilepsy underwent the stereotactic radiosurgery with medium or low dosage guided by PET.Because of the safety and the noninvasive of the treatment,the degree of accuracy of PET imaging indicating lesion area and the real situation shouldn't be considered totally,the treatment target should include all the possible lesions showed by PET imaging.