SEEG引导下射频热凝毁损术在癫痫外科中的应用

The Application of SEEG-guided radiofrequency thermocoagulation in epilepsy surgery

目的总结SEEG引导下射频热凝毁损术治疗药物难治性癫痫的手术疗效及治疗体会。方法对我科2016年12月至2018年5月进行SEEG引导下射频热凝毁损术治疗的13例药物难治性癫痫患者的临床资料进行回顾性分析,并复习相关文献。结果本组纳入病种包括下丘脑错构瘤,侧脑室壁灰质异位结节及其他皮质发育异常。行SEEG引导下射频热凝毁损术后有7例出现短期并发症:3例偏瘫,2例发热、1例中枢性面瘫,1例视物模糊,出院时均完全恢复。术后常规服用抗痫药物,经过3个月至21个月的随访,10例患者EngleⅠ级,2例En-gleⅡ级,1例EngleⅣ级。发作未完全控制患者均再次行开颅手术切除致痫灶,病理分别为FCDⅡa型、MCD(大脑发育畸形)、灰质异位,疗效进一步随访中。结论SEEG引导下射频热凝毁损术是癫痫外科治疗方案中的一项有力补充,选择合适的病例进行射频热凝毁损术安全有效,甚至可以达到无发作。

Objective To summarize the surgical outcome and treatment experience of SEEG-guided radiofrequency thermocoagulation in patients with drug-refractory epilepsy.Methods The clinical data of 13patients with drug-refractory epilepsy who underwent SEEG-guided radiofrequency thermocoagulation were retrospectively analyzed from December 2016to May 2018,and the relevant literature was reviewed.Results The diseases included hypothalamic hamartoma,periventricular nodular heterotopia and other cortical dysplasia.Short-term compli-cations occurred in 7cases after radiofrequency thermocoagulation guided by SEEG:3cases of hemiplegia,2cases of fever,1case of central facial paralysis,1case of blurred vision,but all com-pletely restored at discharge.All the patients take anti-epileptic drugs as usually after surgery.After 3months to 21months of follow-up,10patients obtain Engle I,2patients Engle II,1pa-tient Engle IV.Patients without seizures free underwent craniotomy and resection of the epilepto-genic zone.The pathology was FCD IIa,MCD or gray matter ectopic.The efficacy was further fol-lowed up.Conclusion SEEG-guided radiofrequency thermal coagulation is an userful supple-ment in the surgical treatment of epilepsy.It is safe and effective to choose appropriate cases for radiofrequency thermocoagulation,and can even achieve seizures free.