脑磁图与Wada test结合神经导航在局灶性皮层发育不良所致额颞癫痫外科治疗中的应用

The application research of Magnetoencephalograph, Wada test combined with neuronavigation in the surgical treatment of frontal and temporal epilepsy caused by focal cortical dysplasia

目的探讨脑磁图(Magnetoencephalograph,MEG)、Wada test结合神经导航在局灶性皮层发育不良(Focal cortical dysplasia,FCD)所致额颞癫痫外科治疗中的应用。方法回顾分析河北省人民医院2013年6月—2015年6月期间34例FCD所致额颞癫痫患者病例资料。患者术前行致痫灶定位和智商、记忆和语言评估;行MEG及Wada test,确定语言、记忆优势半球,明确语言功能区范围和记忆功能情况。术中应用美国Medtronic Stealhealth S7手术导航系统引导手术切除FCD,保护神经功能。术后1年复测智商、记忆和语言检查,手术前后数据统计分析。术后随访23~46个月,依照Engel’s分级标准判定癫痫疗效。结果 34例额颞癫痫患者,颞叶癫痫21例,额叶癫痫13例。MEG和Wada test检查过程顺利。MEG能够精确定位语言功能区位置,其中28例患者语言优势为左侧半球,6例为右侧。Wada test可以评估患者记忆功能,其中23例记忆优势半球位于左侧,8例位于右侧,3例位于双侧半球。记忆优势半球及非优势半球比较,记忆评分差异明显(P<0.05)。术后1年言语智商与总智商提高(P<0.05),记忆商、操作智商无明显变化(P>0.05)。FCD患者术后恢复良好,无语言、记忆及肢体功能损伤。癫痫疗效:Engel’s I级15例,Engel’sⅡ级14例,Engel’sⅢ级5例。结论 MEG和Wada test结合神经导航对于FCD所致难治性额颞癫痫患者术前语言和记忆优势半球的定侧、定位和指导手术切除FCD,术中保护皮层功能,避免严重术后并发症,提高了癫痫手术疗效具有重要价值。

Objective To investigate the application of Magnetoencephalograph（MEG）, Wada test combined with neuronavigation in the surgical treatment of frontal and temporal epilepsy caused by focal cortical dysplasia（FCD）.Methods The epileptogenic focus and IQ, memory and language examination were performed in 34 patients with frontal and temporal epilepsy caused by FCD. MEG and Wada test were conducted to determine the language and memory advantage hemisphere, and to clarify the scope and memory function of language function areas. Operation was guided by the Medtronic stealhealth 7 surgical navigation system（USA） to remove the FCD and protect nerve function. IQ, memory and language examination were measured 1 year after operation, and the difference was observed before and after operation. The postoperative follow-up was 23 ~ 46 months, curative effect of epilepsy was determined according to the international anti-epilepsy union Engel＇s standard. Results Thirty-four patients with epilepsy（21 temporal lobe epilepsy and 13 frontal lobe epilepsy） were included in this study. The examination process of MEG and Wada test was smooth.MEG can accurately locate the position of language function area. Twenty-eight patients＇ dominant hemisphere of language was on the left and 6 was on the right side. Wada test can evaluate the patient＇s memory function. Twentythree patients＇ dominant hemisphere of memory was located on the left, 8 on the right and 3 on the bilateral hemisphere. Compared with the dominant hemisphere and nondominant hemisphere, the memory score was significantly different（P0.05）. Statistics showed that the verbal IQ and total IQ increased（P0.05）1 year after operation,but there was no significant change in memory IQ and Performance IQ（P0.05）. FCD patients recovered well without language, memory and limb impairment. The curative effect of epilepsy： 15 cases of Engel＇sgrade, 14 cases of Engel＇sgrade and 5 cases of Engel＇s grade. Conclusion MEG, Wada test combined with neuronavigation was of important value in locating and guiding the surgical resection of FCD in patients with refractory frontal and temporal epilepsy, protecting cortical function, avoiding severe postoperative complications, and improving the therapeutic effect of epilepsy.