难定位难治性癫痫的颅内脑电图-硬膜下电极脑电图与立体定向脑电图应用比较

Comparison of the application of two kinds of iEEG monitoring methods(SEEG vs.SDEG)in patients with“difficult to locate”Intractable Epilepsy

目的探讨两种颅内脑电图(Intracranial electroencephalography,iEEG)监测方式—硬膜下电极脑电图(Subdural ectrodes electroencephalography,SDEG)与立体定向脑电图(Stereoelectroencephalography,SEEG)在"难定位"难治性癫痫患者中应用的优缺点。方法回顾性分析2010年1月—2018年12月于福建医科大学附属第一医院神经外科行iEEG监测下手术治疗的难治性癫痫患者60例,其中SDEG监测49例,SEEG监测11例,观察并统计对比两组患者的致痫灶评估结果、手术疗效及相关并发症的差异性。结果 SDEG与SEEG在致痫灶定位阳性率、手术切除率方面并无显著差异,但可观察到SEEG的双侧植入率(5/11,45.5%)高于SDEG的双侧植入率(18/49,36.7%);SDEG与SEEG监测后行致痫灶切除术的患者术后疗效差异无统计学意义(P>0.05),但由于SEEG病例数有限,目前尚不能得出两者疗效相同的结论;两组患者住院期间出现出血或感染的严重并发症的总发生率的差异具有统计学意义(SDEG 20例vs. SEEG 1例,P<0.05);两组患者住院期间出现明显头痛或脑水肿的总发生率差异有统计学意义(SDEG 26例vs. SEEG 2例,P<0.05),两组患者癫痫切除术后出现脑脊液漏、切口皮下积液、切口愈合不良的总发生率的差异具有统计学意义(SDEG 14例vs. SEEG 0例,P<0.05);两组患者切除术后出现的言语、肌力等功能障碍的差异无统计学意义(P>0.05)。结论 SEEG的并发症较SDEG更少,安全性更高;两种iEEG监测方式在致痫灶的定位及功能区的区分方面各有优势,未来两种方式的有效结合或将更有利于定位致痫灶及功能区。

Objective To explore the advantages and disadvantages of using two intracranial EEG(iEEG monitoring methods-Subdural ectrodes electroencephalography(SDEG)and Stereoelectroencephalography(SEEG),in patients with"difficult to locate"Intractable Epilepsy.Methods Retrospectively analyzed the data of 60 patients with SDEG monitoring(49 cases)and SEEG monitoring(11 cases)from January 2010 to December 2018 in the Department of Neurosurgery of the First Affiliated Hospital of Fujian Medical.Observe and statistically compare the differences in the evaluation results of epileptic zones,surgical efficacy and related complications of the two groups of patients,and review the relevant literature.Results The results showed that the two groups of SDEG and SEEG had no significant difference in the positive rate and surgical resection rate of epileptogenic zones,but the bilateral implantation rate of SEEG(5/11,45.5%)was higher than that of SDEG(18/49,36.7%).At present,there was no significant difference in the postoperative outcome among patients with epileptic zones resected after SDEG and SEEG monitoring(P>0.05).However,due to the limitation of the number of SEEG cases,it is not yet possible to conclude that the two effects were the same.There was a statistically significant difference in the total incidence of serious complications of bleeding or infection between the two groups(SDEG 20 cases vs.SEEG 1 case,(P<0.05).There was a statistically significant difference in the total incidence of significant headache or cerebral edema between the two groups(SDEG 26 cases vs.SEEG 2 cases,P<0.05).There was a statistically significant difference in the incidence of cerebrospinal fluid leakage,subcutaneous fluid incision,and poor healing of incision after epileptic resection(SDEG 14 cases vs.SEEG 0 case,P<0.05);there were no significant differences in dysfunction of speech,muscle strength between the two groups(P>0.05).Conclusion SEEG has fewer complications than SDEG,SEEG is safer than SDEG.The two kinds of iEEG monitoring methods have advantages in the localization of epileptogenic zones and the differentiation of functional areas.The effective combination of the two methods in the future may be more conducive to the location of epileptic zones and functional areas.