立体定向颅内脑电图在难治性癫痫治疗中的价值(附30例临床分析)

The value of stereotactic intracranial electroencephalography in the treatment of refractory epilepsy:a clinical analysis of 30 cases

目的探讨立体定向颅内脑电图技术(SEEG)在难治性癫痫术前评估及癫痫灶定位中的作用与价值。方法回顾性分析中国医科大学航空总医院癫痫中心对于头皮脑电、电子计算机断层扫描(computed tomography,CT)、头颅磁共振(MRI)难以定位的药物难治性癫痫患者30例,根据其临床和术前影像学检查结果,设计SEEG方案并进行电极置入,长程记录发作3次以上并给予电刺激,结合发作间期及发作期深部脑电图确定致痫灶,手术切除后随访患者发作改善情况。结果15例患者监测到局灶性发作,13例监测到区域性发作,2例患者监测到频繁全面性发作,30例患者均无电极植入后并发症,其中28例参照颅内脑电图结果行外科手术治疗,术后随访6~18个月,癫痫发作消失18例,5例缓解90%,5例缓解50%以上,无手术并发症。结论立体定向颅内脑电图在头皮脑电及磁共振难以明确致痫灶的难治性癫痫治疗中有重要的地位,为癫痫外科提供定位诊断价值,提高手术效果,减少手术并发症。

Objective To explore the role and value of stereotactic intracranial electroencephalography(SEEG)in preoperative evaluation of refractory epilepsy and localization of epileptic foci.Methods Retrospective analysis of scalp electroencephalography and computed tomography(CT)performed by the Epilepsy Center of Aviation General Hospital of China Medical University.,head of magnetic resonance(MRI)is difficult to locate 30 patients with intractable epilepsy,according to the results of the clinical and imaging examination preoperatively,design SEEG scheme and electrode placement,long-range attacks more than 3 times and gives the electrical stimulation,the interphase and combined with seizures epileptogenic zone of deep electroencephalography(eeg)to determine,to improve the follow-up of patients after surgical removal of the attack.Results 15 patients were detected by focal seizures,13 cases detected by regional attack,frequently detected comprehensive attack,2 cases with no complications after electrodes in 30 patients,28 cases with reference to the surgical treatment of intracranial eeg result row,postoperative follow-up 6~18 months,seizures disappeared 18 cases,5 cases were 90%,5 cases with ease by more than 50%,no complications.Conclusion Stereotactic intracranial electroencephalography(EEG)plays an important role in the treatment of intractable epilepsy with intractable epilepsy that is difficult to identify epileptic foci due to scalp electroencephalography and magnetic resonance(MRI),and provides localized diagnostic value for epilepsy surgery,improves surgical effect and reduces surgical complications.