基于多模态影像的立体定向脑电图在药物难治性癫痫治疗中的应用

Application of SEEG based on multimodal imaging in the treatment of drug-refractory epilepsy

目的:探讨多模态影像立体定向脑电图(SEEG)在药物难治性癫痫治疗中的应用效果。方法:选取医院诊治的67例药物难治性癫痫患者,所有患者均于术前行多模态影像评估,结合临床资料设计置入SEEG电极的方案,按照SEEG确定病因并制定手术方案,术中指导切除致痫灶,术后随访评估治疗疗效。结果:对67例患者置入SEEG电极共794根,共有触点8080个,平均SEEG电极(11.85±3.35)根,触点74~169个,平均触点(120.60±27.73)个,SEEG电极置入监测时间5~11 d,平均监测时间(7.91±1.39)d,SEEG电极置入耗费时间91~210 min,平均耗费时间(150.57±41.65)min,SEEG电极置入出血量5~11 ml,平均出血量(8.25±2.43)ml,SEEG电极置入的实际靶点和计划靶点的误差1~2 mm,平均误差(1.63±0.49)mm。67例患者中1例术后发生置入区域硬膜外血肿,未出现神经功能的缺损、严重出血、脑脊液漏、感染、SEEG电极移位或折断等并发症。67例患者中2例未完成手术,其余65例均完成致痫灶切除术,术后随访时间7~16个月,平均随访时间(11.61±3.30)个月。发作控制恩格尔(Engle)分级中Ⅰ级52例(占80.00%),Ⅱ级2例(占3.08%),Ⅲ级7例(占10.77%),Ⅳ级4例(占6.15%)。结论:在药物难治性癫痫治疗中,采用基于多模态影像的SEEG可有效检出致痫灶,且高效安全,可应用于药物难治性癫痫的手术治疗中。

Objective:To investigate the application effect of stereotaxic electroencephalography(SEEG)using multimodal imaging in the treatment of drug-refractory epilepsy.Methods:A total of 67 patients with drug-refractory epilepsy who were diagnosed and treated in hospital were selected.All patients underwent multimodal imaging assessment before surgery.The scheme of SEEG electrode placement was designed by combining the clinical data.As SEEG,the reason of disease was determined,and a surgical plan was formulated.In addition,the lesion of causing epilepsy was resected as the intraoperative guidance with SEEG,and the curative effect of the treatment was assessed by postoperative follow-up with SEEG.Results:A total of 794 SEEG electrodes were implanted in 67 patients,with a total of 8080 electric shocks.The average SEEG electrodes were(11.85±3.35),and the electric shocks was 74-169,and the average electric shocks were(120.60±27.73).The monitoring time of SEEG electrode placement was 5-11 d,and the average time was(7.91±1.39)d.The time-consuming of SEEG electrode placement was 91-210 min,and the average time-consuming of that was(150.57±41.65)min.The amount of bleeding of SEEG electrode placement was 5-11mL,and the average amount of that was(8.25±2.43)mL.The error of SEEG electrode placement between actual target point and planning target point was 1-2 mm,and the average error of that was(1.63±0.49)mm.One case of 67 patients occurred epidural hematoma in the implantation area after surgery,and there were no complications such as defects of neurological function,severe bleeding,cerebrospinal fluid leakage,infection,displacement or fracture of SEEG electrodes in these patients.Two cases of the 67 patients did not complete the operation,and the other 65 patients completed the resection for the lesion of causing epilepsy.The follow-up time post operation was 7-16 months,and the average follow-up time was(11.61±3.30)months.In the Engle grading of seizure control,52 cases were grade Ⅰ(80.00%),and 2 cases were grade Ⅱ(3.08%),and 7 cases were grade Ⅲ(10.77%),and 4 cases were grade Ⅳ(6.15%).Conclusion:In the treatment of drug-refractory epilepsy,the SEEG based on multimodal imaging can effectively detect the causative lesion,which is high efficiency and safety.It can be used in the surgical treatment of drug-refractory epilepsy.