立体定向脑电图在药物难治性癫术前侵袭性评估中的应用价值和安全性

Application and safety of stereoelectroencephalography in invasive preoperation evaluation of drug-refractory epilepsy

目的探讨立体定向脑电图(SEEG)在药物难治性癫(DRE)术前侵袭性评估中的应用价值和安全性。方法回顾性分析2016年8月至2018年11月在深圳市第二人民医院和深圳大学总医院开展SEEG置入的DRE患者的临床资料。根据患者无创的评估检查,提出可疑致灶位置和传播路径的假设,制定SEEG置入方案,最后根据SEEG和电刺激结果,制定最终手术切除或射频热凝方案,完成外科手术。结果31例DRE患者共成功置入电极359根电极,平均11.58根/人,电极置入失败13根(3.62%),无追加电极置入情况。术后出现迟发性颅内出血1例,未出现颅内感染、脑脊液漏等并发症。SEEG置入后,20例患者行致灶切除,8例患者行致网络射频热凝术,1例致灶位于功能区行迷走神经刺激术,2例患者未行手术治疗。31例患者随访时间为6~30个月,平均为(11.68±7.46)个月。20例行致灶切除术患者术后国际抗癫联盟(ILAE)分级Ⅰ级17例(85.00%,17/20)、Ⅱ级2例(10.00%,2/20)、Ⅲ级1例(5.00%,1/20),8例行致网络射频热凝术患者术后ILAEⅠ级6例(75.00%,6/8)、Ⅲ级2例(25.00%,2/8),2种不同治疗手段间的疗效差异无统计学意义(P=0.61)。13例磁共振成像(MRI)阴性患者中术后ILAEⅠ级10例(76.92%,10/13)、Ⅱ级2例(15.38%,2/13)、Ⅲ级1例(7.69%,1/13),15例MRI阳性患者中术后ILAEⅠ级13例(86.67%,13/15)、Ⅲ级2例(13.33%,2/15),两者间疗效差异无统计学意义(P=0.64)。结论无论是MRI阳性还是MRI阴性的DRE病例,SEEG均可以提高致灶定位的精准性,SEEG指导下外科治疗DRE是安全、有效的。

Objective To investigate the application and safety of stereoelectroencephalography(SEEG)in invasive preoperation evaluation of drug-refractory epilepsy(DRE).Methods We retrospectively analyzed the clinical data of patients with DRE who underwent SEEG implantation in Shenzhen Second People’s Hospital and Shenzhen University General Hospital between Aug.2016.and Nov.2018.The suspicious epileptogenic focus and propagation path was proposed based on the non-invasive preoperative evaluation,and then the implantation protocol of the SEEG electrodes was designed.Finally,according to the SEEG and electrical stimulation results,the resection or thermocoagulation of suspicious epileptogenic focus was done.Results A total of 359 electrodes were implanted in 31 DRE patients,with an average of 11.58 per patient.There were 13 electrodes(3.62%)failed to be implanted,with no additional electrode implantation.One case of intracranial hemorrhage was noted after operation,and there was no intracranial infection or cerebrospinal fluid leakage.Twenty patients received epileptogenic zone resection,8 received epileptic network radiofrequency thermocoagulation,1 with epileptic foci in the eloquent cortex underwent vagus nerve stimulation,and 2 received no operation.Thirty-one DRE patients were followed up for 6-30 months,with an average of(11.68±7.46)months.Of the 20 patients who underwent epileptogenic zone resection,17 patients (85.00%, 17/20) had grade Ⅰ ILAE (International League Against Epilepsy), 2 (10.00%, 2/20) had grade Ⅱ, and1 (5.00%, 1/20) had grade Ⅲ. For the 8 patients undergoing epileptic network radiofrequency thermocoagulation, 6 (75.00%,6/8) had grade ⅠILAE and 2 (25.00%, 2/8) had grade Ⅲ. There was no significant difference in outcome between the twotreatments (P=0.61). For 13 patients with negative magnetic resonance imaging (MRI), 10 (76.92%, 10/13) had grade ⅠILAE, 2 (15.38%, 2/13) had grade Ⅱ, and 1 (7.69%, 1/13) had grade Ⅲ;for 15 MRI-positive patients, 13 (86.67%, 13/15)had grade Ⅰ ILAE and 2 (13.33%, 2/15) had grade Ⅲ. There was no significant difference in outcome between MRI-positivepatients and MRI-negative patients (P=0.64). Conclusion Surgical treatment of DRE patient under the guidance of SEEGis safe and effective, and SEEG can improve the accuracy of epileptogenic foci localization, no matter in MRI positive or MRInegative patients.