岛叶立体定向电极植入方法及传导通路的初步探讨

A brief discussion on stereotaxic electrode implantation methods and epileptic discharge propagation related to the insula

目的探讨岛叶立体定向电极植入方法,观察与岛叶相关异常放电的传导通路。方法根据术前检查结果,其致痫灶可能与岛叶相关的患者,通过综合应用神经导航结合脑立体定向技术采用斜交法及正交法植入岛叶立体定向电极,并分析两种方法的利弊,结合其它立体定向电极,对岛叶相关的传导通路进行初步探讨。结果7例药物难治性癫痫患者岛叶植入立体定向电极17根,斜交法植入12根,平均每根电极在岛叶触点5.75个,正交法植入5根,平均每根电极在岛叶触点1.2个,经额及经顶联合植入可覆盖岛叶大部分脑回。监测发作期视频脑电图发现岛叶参与多条传导通路的传播。结论岛叶斜交法及正交法立体定向电极植入均安全可靠,且能证明岛叶相关异常放电传导通路。

Objective To explore the stereotactic electrode implantation methods and observe the epileptic discharge propagation related to the insular lobe.Methods Patients whose epileptogenic zone may be associated with the insula according to preoperative evaluation were recruited and underwent SEEG operation with orthogonal-transopercular electrode trajectory or transparietal and transfrontal Oblique trajectory,then analysis on advantages and disadvantages of two methods were taken out.Given the other stereotactic electrodes,we explored the epileptic discharge propagation related to the insular lobe.Results 7patients with refractory epilepsy were implanted into 17 electrode with stereotactic,5of which were through orthogonal-transopercular trajectory and resulted in 1.2lead contacts beingpositioned within the insula per electrode while the other 12 yielded 5.75 contacts per electrode.In addition,transparietal and transfrontal oblique trajectory can cover most of gyrus of the insula.Video electroencephalography monitoring found that the insula participate in multiple trasmission paths.Conclusion Stereotactically using orthogonal or oblique trajectories are both safe and reliable,and indicates abnormal discharge pathway related to the insula.