直接电刺激在脑功能区病变性癫痫手术中的应用

Application of intraoperative direct electrical stimulation in epilepsy surgery involving eloquent areas

目的 探讨术中直接电刺激（direct electrical stimulation,DES）联合持续皮质脑电监测（electrocorticography,ECoG）在脑功能区病变性癫痫手术中的应用.方法 回顾性分析2007年4月至2012年7月经手术治疗的脑功能区病变性癫痫49例.所有患者术中联合应用皮质及皮质下DES与持续ECoG监测技术.结果 48例成功识别定位功能区.术后神经功能情况：术后1周评估,12例神经功能障碍加重,均于术后半年内逐渐改善;术后半年评估,3例遗留永久性神经功能障碍.癫痫控制情况：随访1.5 ～6.0年,平均（40.0±14.4）个月,Engel Ⅰ级34例,Ⅱ级6例,Ⅲ级3例,Ⅳ级1例.结论 脑功能病变性癫痫手术中联合应用皮质及皮质下DES和持续ECoG监测技术能够相对准确、安全、可靠地识别定位脑功能区,并协助定位致痫皮层,达到减少术后永久性神经功能障碍发生率,改善癫痫控制效果的目的.

Objective To report the experience on application of intraoperatvie direct electrical stimulation（DES） and continuous electrocorticography （ECoG） monitoring in surgical treatment of lesional epilepsy involving eloquent areas.Methods 49 consecutive epilepsy patients with structural lesions adjacent to eloquent areas from our institute between April 2007 and July 2012 were included.The patients were processed one-stage surgery with combined application of intraoperative DES and continuous ECoG monitoring.Results 48 patients successfully identified the eloquent area.One week after surgery,12 patients suffered worsened neurological dysfunction.At 6 months follow-up,3 patients had persistent worsened neurological dysfunction.Following up 1.5-6.0 years （mean 40.0 ± 14.4 months） in 47 patients,34 patients with Engels class Ⅰ,6 with class Ⅱ,3 with class Ⅲ,1 with class Ⅳ,and the total effective rate（patients in Engle＇s class Ⅰ and Ⅱ）was 81.6％.Conclusion Combined application of intraoperative DES and continuous ECoG monitoring can identify the eloquent area precisely,safely and reliably,and also can assist to localize epileptogenic foci.This technique can achieve good seizure outcome meanwhile decreasing incidence of neurological dysfunction for lesional epilepsy involving eloquent areas.