PET引导放射外科治疗多致痫灶性癫痫

PET-guided radiosurgery for multiple foci intractable epilepsy

目的探讨放射外科治疗多致痫灶性顽固性癫痫中放射靶区确定的方法。方法69例PET显像提示多致痫灶的病人,行直线加速器放射外科治疗。A组,21例,靶区为PET提示的致痫灶;B组,48例,靶区包括PET提示的致痫灶和可疑致痫灶。随访3～16个月。结果两组病例在3个时间点上均观察到癫痫发作频率较前明显降低,但B组的发作频率明显低于A组。疗效I-II级病人的比例,B组(48.6%)高于A组(33.3%);疗效Ⅴ-Ⅵ级病人的比例,A组(22.2%)高于B组(14.3%)。所有病例未见明显并发症。结论PET引导放射外科治疗顽固性癫痫,具有较高的有效率。难以鉴别PET显像中的假阳性病灶;放射外科靶区似乎应包括PET提示的所有病灶,才有较好的疗效。

Objective To explore the method of outlining target of radiosurgery for multiple foci intractable epilepsy.Method69patients with multiple epileptic foci localized by PET imaging were treated by LINAC radiosurgery and divided into two groups based on the different target(Group A,21cases,target include only all obvious foci;Group B,48cases,target include all obvious and doubtful foci).All the patients had a follow-up period of3-16months.Result The seizure frequency decreased postoperatively on both groups.The frequency of B decreased more than A.According to Wieser's classification of operative effect,In group A,33.3%was classified as grade1or2,22.2%as grade5or6,In group B,48.6%was classified as grade1or2,14.3%as grade5or6.The surgical outcome of group B was better than group A.There were no severe complications,no disability and mortality.Conclusion It's safe and significant effect that the patients with intractable epilepsy underwent the radiosurgery guided by PET.It is implied that the degree of accuracy of PET imaging indicating lesion area and the real situation shouldn't be considered totally,the treatment target should include all the possible lesions showed by PET imaging.