立体定向颅内电极植入后癫痫灶切除时机的选择

A study of the timing of epileptogenic zonectomy implantation

目的初步探讨机器人立体定向辅助系统（ROSA）引导颅内电极植入后，癫痫灶切除手术时机的选择。方法回顾性分析2012年3月至2015年12月在首都医科大学三博脑科医院采用ROSA引导颅内电极植入并行癫痫灶切除的132例患者的临床资料及手术时机。其中5例行癫痫灶切除＋功能区皮质电凝热灼术。结果电极拔除后当日手术16例（12.1%）；1周内手术10例（7.6%）；1周至1个月内手术33例（25.0%）；1～3个月内手术27例（20.5%）；3个月后手术46例（34.8%）。术后4例（3.0%）感染：其中1例为电极拔除后16 d手术，1例为电极拔出后65 d手术，1例为电极拔除后109 d手术，1例为电极拔出后120 d手术，经治疗均痊愈出院。各时间段的感染率比较差异无统计学意义（P〉0.05）。结论ROSA引导颅内电极植入定位癫痫灶后，癫痫灶切除手术时机的选择（距离电极拔出时间的长短）与颅内感染无关，可以根据具体情况个体化选择手术切除时间。

Objective To explore the correlation between cranial infection and the timing of epileptogenic zonectomy following intracranial electrode implantation assisted by robotized stereotactie assistant （ROSA）. Methods The clinical data of 132 epilepsy patients admitted to Beijing Sanbo Brain Hospital from March 2012 to December 2015 who underwent implantation of intracranial electrodes assisted by ROSA and resection of epileptogenic zones, including 5 cases undergoing epileptogenic zonectomy combined with bipolar electro-coagulation on functional cortex （BCFC）, were collected and retrospectively analyzed. Results Sixteen patients （ 12.1% ） underwent surgical resection on the day of electrode removal; 10 patients （7.6%） received surgical resection within 1 week post intraeranial electrode removal; 33 patients （25%） underwent surgical resection from 1 week to 1 month following intracranial electrodes removal ; 27 patients （20.5%） experienced surgical resection from 1 to 3 months post electrode removal; and the remaining 46 patients （34. 8% ） underwent epileptogenic zonectomy 3 months post electrode removal. Postoperative intracranial infection was noted in 4 patients （3.0%） , who underwent surgical resection 16, 65, 109 and 120 clays after electrode removal, respectively. The infection was subsequently cured in all cases with conservative therapy. There was no statistical difference in the infection rate between groups varying in timing of epileptogenic zonectomy （P = 0. 839 ）. Conclusion There seems to be no statistical correlation between cranial infection and the timing of epileptogenic zone resection following intracranial electrode removal.