立体脑电图在癫痫再次手术中的应用

The role of stereoelectroencephalography(SEEG)in repeat epilepsy surgery

目的探讨立体脑电图(SEEG)在癫痫再次手术评估中的作用。方法回顾性纳入2011年8月至2018年1月首都医科大学三博脑科医院功能神经外科收治的SEEG监测前有癫痫手术史且监测中有癫痫发作的患者,共39例。分析SEEG的评估结果及再次手术的疗效。结果39例患者中,SEEG起始部位与初次手术部位临近者14例(36%);不临近者25例(64%),其中主要为同侧远隔部位,共21例(54%)0起始波形以高频放电最多,共19例(49%);其次为低波幅快节律,共8例(21%)。起始脑区范围:单脑叶32例(82%),多脑叶7例(18%)。SEEG评估后未行手术者4例,再次手术者35例。术后随访时间≥12(12-51)个月者33例,Engel分级I级者16例(49%),Ⅱ级者3例(9%).Ⅲ级者2例(6%),Ⅳ级12者例(36%)。39例中,19例初次手术切除范围包括颖前叶及内侧颖叶结构,经SEEG评估后,17例行再次手术,术后随访时间A12个月者16例,Engel分级I级者8例。统计学分析结果显示.SEEG评估显示发作起始部位是否临近初次手术部位、起始是否为高频放电、起始于单个或多脑叶,再次手术方式是否包括切除术、病理学结果是否确切、初次手术单纯颖前叶及颖叶内侧结构切除与否比较,预后Engel分级I级者差异均无统计学意义(均P>0.05)。结论应用SEEG行癫痫再次手术评估,近半数患者可获得无发作的疗效;再次手术的成功率主要与致痫区定位的准确性有关。

Objective To expl ore the role of stereoelectroencephalography(SEEG)in evaluation of epilepsy resurgery.Methods Thirty-nine patients with a surgical failure and clinical seizures in the SEEG monitoring were retrospectively included in this study at Department of Founctional Neurosurgery,Sanbo Brain Hospital,Capital Medical University from August 2011 to January 2018.The evaluation results from application of SEEG and efficacy of resurgery were analyzed.Results The seizure onset zone(SOZ)located in the neighboring areas around the initial surgical region in 14(36%)patients,and in the nonneighboring areas in 25(64%)patients,among whom SOZ located in the same side as the initial surgical region but far apart from it in 21 patients(54%).High frequency discharges were the most common SEEG pattern of seizure onset with a total of 19 cases(49%),followed by the low voltage fast activities with a total of 8 cases(21%).The seizure onset from single brain region was shown in 32 cases(82%),and that from multi brain regions was shown in 7 cases(18%).After SEEG evaluation,4 patients did not undergo surgical treatment,and the remaining 35 cases were followed by re-surgery.There were 33 cases followed up more than 12(12-51)months in total,among whom 16 cases(49%)classified as Engel 1,3 cases(9%)Engel Ⅱ,2 cases(6%)Engel Ⅲ,and 12 cases(36%)Engel IV.Nineteen cases undergone anterior temporal lobectomy in the first surgery,and 17 cases were re-operated after SEEG evaluation,among whom 16 cases were followed up more than 12 month and 8 cases were classified as Engle I.Conclusions Nearly half of patients achieved seizure freedom after repeated surgery by SEEG evaluation.The success rate of epilepsy resurgery is mainly related to the accuracy of localization of epileptogenic zone.