立体定向辅助系统引导颅内电极置入术在致痫灶定位中的作用

The role of ROSA navigated intracranial electrode implantation technique on precise epileptogenic zone localization

目的 初步探讨机器人立体定向辅助系统（ROSA）引导下颅内电极置入术在致痫灶精确定位中的作用.方法 回顾性分析北京三博脑科医院2012年3月至2013年9月采用ROSA引导下的颅内电极置入术的40例局灶性药物难治性癫痫患者的资料.资料包括患者的自然情况、非侵袭性检查资料、电极置入后致痫灶的检出率、并发症以及手术疗效.结果 ROSA引导下颅内电极置入共40例,其中39例完成电极置入并行视频脑电监测.1例因出现颅内出血而中止电极置入.电极留置颅内4 ～34 d,平均11.4d;捕捉到临床发作2～38次,平均9.9次.置入电极后无一例出现脑脊液外漏、颅内血肿、电极折断或死亡.1例出现头皮感染.37例明确致痫灶,其中32例行局灶性切除手术.术后随访结果：Engel Ⅰ级27例、Ⅱ级2例、Ⅲ级1例、Ⅳ级2例.结论 采用颅内电极置入并进行长程脑电图监测是定位难治性癫痫致痫灶的一种有效方法,特别是ROSA引导下的立体定向电极置入术,因其微创、手术时间短、安全、致痫灶定位精确,故而可以有效地指导致痫灶的精确切除.

Objective To evaluate the application of robotized stereotactic assistant （ROSA） navigated intracranial electrode implantation in precise epileptogenic zone localization.Methods The data of 40 patients with drug-resistant epilepsy in Beijing Sanbo Brain Hospital from March 2012 to September 2013 who underwent ROSA navigated implantation of intracranial electrode for localization of epileptogenic zone were collected.The demographics,noninvasive clinical data,complications and seizure outcomes after surgical resection were prospectively collected and analyzed.Results Thirty-nine patients proceeded videoelectroencephalography （V-EEG） without distraction.1 patient experienced intracranial hemorrhage caused by the implantation.The electrodes were preserved for 4-34 days （mean 11.4 days）,and 2-38 clinical seizures were observed with a mean of 9.9.There was no cerebrospinal fluid leak,intracranial hematoma,electrodes fracture or patient death.There was 1 scalp infection.From the studied group of 39 patients,the area of seizure onset could be localized in 37 patients.32 patients underwent surgical resection following stereo-electroencephalography （SEEG） evaluation and were followed-up for more than 6 months.In the group of 32 patients,27 patients were reached Engel Ⅰ class,2 Engel Ⅱ,1 Engel Ⅲ and 2 Engel Ⅳ.Conclusions For intractable epilepsy,when non-invasive assessments couldn＆#39;t find the epileptogenic foci,intracranial electrode implantation combined with long-term Ⅴ-EEG was an effective method to localize the epileptogenic foci,especially the ROSA navigated stereotactic electrode implantation,which was a microinvasive,short-time,less-complication,safe-guaranteed and precise technique.