颅内电极脑电图监测技术在儿童癫痫手术中的应用

A clinical study of intracranial electroencephalography in pediatric epilepsy surgery

目的探讨颅内电极皮质脑电监测技术在儿童癫痫患者中的应用。方法回顾性分析2004年9月到2013年9月在我院接受颅内电极埋置手术的173例儿童癫痫患者的临床资料,总结其手术技术、并发症及术后效果。结果 173例儿童患者手术时平均年龄为(12.7±3.8)岁,颅内电极脑电图监测时间平均为(5.4±1.3)d,37例患者(21.4%)出现并发症,其中颅内血肿18例,脑水肿6例,脑脊液漏8例,术口感染3例,电极折断2例,颅骨骨髓炎3例,无永久性神经功能缺失患者。术后随访平均47个月±17个月,84例患者(48.9%)未再出现发作(Engel I级),41例(23.3%)发作显著减少(Engel II级)。结论长程颅内电极皮质脑电监测技术,有助于儿童癫痫患者的致痫灶定位诊断,提高手术疗效。合理制定电极埋置方案,注意操作细节及技巧,可降低颅内血肿等并发症的发生风险。

Objective The method of intracranial dectrode implantation, EEG recordings and surgical outcomes in children with epilepsy are investigated. Methods The clinical data for 173 children with epilepsy （mean age,12. 7 ± 3. 8 years） who underwent intracranial EEG monitoring with the implantation of strip, grid subdural electrodes and/or intracerebral depth electrodes from September 2004 to September 2013 at our epilepsy center were reviewed retrospectively. Results The mean age of 173 cases was 12.7±3.8. The mean duration of implantation was 5.4 ±1.3 d. Complications were documented in 37 （21.4%） patients： intracranial hematoma in 18 cases, cerebral edema in 6 cases, cerebrespinal fluid leakage in 8 cases, incision infection in 3 cases, electrode fracture in 2 cases, osteomyelifis of the skull in 3 cases, and no permanent neurological deficits. All the patients were followed up for 47 ± 17 months. Among these patients, 84 （48.9%） were seizure free （ Engel Class I）, which was 〉 2 years after surgery; 41 （23.3%） patients had a significant reduction in seizures （Engel Class II）. Conclusion The results show that the intracranial electroencephalographic monitoring in children provides the good surgical outcomes and the level of risk is acceptable. Proper electrode placement and gentle operation technique can minimize the risk of intracranial hematoma of the electrode during the monitoring period.