立体定位脑电图长程监测在顽固性癫痫致痫灶定位中的应用

The location of the epileptogenic zone by long term sEEG

目的：探讨立体定向技术植入的深部电极构成的立体定位脑电图对药物难治性癫痂致痼灶的定位阳性率和近期手术效果。方法：对于头皮脑电、CT、MRI难以确定致痫灶位置的药物难治性癫痫的10例患者，采用立体定向方法植入深部电极2根6例、3根4例，长程记录发作3次以上，结合发作间期和发作期深部电极脑电确定致痫灶，外科治疗后随访术后发作改善情况。结果：外科术前监测106例，实行手术33例，其中10例患者需要植入深部电极辅助定位。此10例中无植入电极并发症，均有发作间期局灶痫样放电和发作期局灶性起源位置，其中局灶性起源7例、区域性起源3例。参照深部电极脑电图结果采取外科手术治疗，术后9～20个月，癫痫缓解4例，2例好转90％以上，4例好转50％以上，无手术并发症。结论：立体定位脑电图可对头皮脑电难以确定致痫灶的患者进行定位，为外科提供定位性诊断信息，提高外科手术效果。

Objective：To investigate the application of stereo-electroencephalography（sEEG） in the location of intrable epilaptogenic zone by depth electrode implanting technigue through positive rate in finding epileptic onset zone and explore the recent outcome of surgeries. Methods： Depth electrode im- plantation was performed by using Leksell system in 10 patients with intractable epilepsy, for CT, MRI and EEG were unfit to locate epileptic onset zone. 24 depth electrodes were implanted（2 in 6 patients and 3 in 4 patients） and the depth electrogram recorded 3 or more seizures. By with the location of the onset zones on depth electrograms, surgeries were performed. Results： All the 10 patients had epileptic onset zones on depth electrograms. 9 to 20 months after operation,4 patients were seizure free,and 2 patients were 90~ better than in preoperation, 4 patients were 50 % better. Conclusion： Stereo-electroencephalo- graphy can locate the epileptic onset zone to improve operation for patients with intractable epilepsy.