国产磁共振引导激光间质热疗治疗药物难治性癫痫的安全性及短期有效性观察

Safety and short-term efficacy of domestic magnetic resonance-guided laser interstitial thermotherapy in the treatment of drug-resistant epilepsy

目的了解国产磁共振引导激光间质热疗(MRgLITT)治疗药物难治性癫痫的安全性及短期有效性。方法前瞻性纳入首都医科大学宣武医院神经外科2020年10月至2021年4月使用国产MRgLITT系统治疗的药物难治性癫痫患者22例。术后即刻评估毁损容积比,记录围手术期并发症并随访,临床疗效评估采用Engel分级标准以评估该治疗的安全性和短期有效性。结果22例患者,其中男12例,女10例,年龄3-45(24±13)岁。癫痫类型包括:内侧颞叶癫痫(MTLE)5例,下丘脑错构瘤(HH)3例,局灶皮质发育不良(FCD)7例,其他类型7例。手术时间101-308(173±49)min,手术出血1-5(3.7±1.6)ml,手术后3-10(5.5±1.8)d出院,平均毁损容积比为92.6%。其中仅2例患者(顶叶FCD)术后出现一过性对侧肢体无力,未出现症状性颅内出血、脑梗死等严重并发症。随访时间为14-168 d。Engel分级Ⅰ级者13例(59.1%),Ⅱ级者2例(9.1%),Ⅲ级者2例(9.1%),Ⅳ级者5例(22.7%)。短期无发作率分别为MTLE 5/5和FCD 4/7。结论国产MRgLITT系统治疗药物难治性癫痫微创、安全、可靠,对MTLE、FCD短期疗效更好。

Objective To investigate the safety and short-term efficacy of domestic magnetic resonance-guided laser interstitial thermotherapy(MRgLITT)in the treatment of drug-resistant epilepsy.Methods Patients with drug-resistant epilepsy treated with a domestic MRgLITT system in the Department of Neurosurgery,Xuanwu Hospital,Capital Medical University from October 2020 to April 2021 were prospectively enrolled.The damage volume ratio was assessed immediately after surgery,and perioperative complications were recorded and followed up.The clinical safety and short-term efficacy were evaluated using the Engel classification.Results A total of 22 patients were included,including 12 males and 10 females,aged from 3 to 45 years old[(24±13)years].There were 5 cases of medial temporal lobe epilepsy(MTLE),3 cases of hypothalamic hamartoma(HH),7 cases of focal cortical dysplasia(FCD),and 7 cases of other types,respectively.The mean operation time and blood loss was(173±49)min and(3.7±1.6)ml.The postoperative length of hospital stay was(5.5±1.8)days,and the average damage volume ratio was 92.6%.Among them,only 2 patients(FCD of the parietal lobe)showed transient contralateral limb weakness,without any serious complications such as symptomatic intracranial hemorrhage and cerebral infarction.The follow-up time was 14 to 168 days.There were 13 Engel classⅠcases(59.1%),2 Engel classⅡcases(9.1%),2 Engel classⅢcases(9.1%)and 5 Engel classⅣcases(22.7%),respectively.Short-term incident-free rates were MTLE 5/5and FCD4/7,respectively.Conclusion Domestic MRgLITT system is stable,reliable and safe in the treatment of drug-refractory epilepsy,and has better short-term efficacy in MTLE and FCD patients.