神经导航下SEEG在儿童难治性癫痫术前评估中的应用

Application of neuronavigation SEEG in preoperative evaluation of intractable epilepsy in children

目的研究神经导航下颅内深部电极置入方法的安全性及可行性。方法 21例儿童难治性癫痫患者,年龄3岁至16岁。在美敦力S7影像处理系统上进行患者脑部影像及脑表面血管的三维重建,根据术前计划,设计合适的电极靶点、入点,利用美敦力S7神经导航系统置入立体定向电极。结果 2016年3月至2017年5月应用上述系统及方法完成21例立体定向电极置入手术,共置入电极139根,平均6.6根。最小年龄3岁,最低体重13.3KG,置入区域覆盖全脑叶,颅内电极最长保留时间21天,平均单根电极置入操作时间10分钟。21例患者无一例出现出血感染等并发症,其中1例行二次手术补置电极1根,亦无并发症出现。术后癫痫Engle评分为Ⅰ级20例,Ⅱ级1例。结论应用美敦力S7神经导航系统可以在儿童难治性癫痫患者中开展立体定向脑电图技术,其方法安全可靠。

Objective To study the safety and feasibility of deep intracranial electrode implantation in children under neuronavigation.Methods A total of 21 children with treament-resistant epilepsy were enrolled,age range from 3 to 16 years.In the Medtronic S7 image processing system,three-dimensional reconstruction of the patient＇s brain images,cerebral surface vessels,according to the preoperative electrode implantation plan,design appropriate electrode target and access point,implanted stereotactic electrode using of Medtronic S7 navigation system.ResultsFrom March 2016 to May 2017,21 cases of stereotactic electrode implantation were performed with the Medtronic system.A total of 149 electrodes were implanted,the average was 6.6 electrodes.The youngest was 3 years old and the lowest weight was 13.3 Kg,the region covering the whole brain.The longest preservation time was 21 days,and the average single electrode implantation time was 10 minutes.None of the 21 patients suffered from complications such as bleeding or infection.1 of them underwent two operations,and had no complications.Postoperative epilepsy Engle scores was Ⅰ grade in 20 cases,Ⅱ grade in 1 case.Conclusion It is safe and reliable to carry out stereotactic EEG implantation using Medtronic S7 navigation system in children.