局灶性皮质发育不良Ⅱ型癫痫射频热凝病灶毁损程度与疗效的相关性研究

Study on the correlation between the degree of damage and efficacy of radiofrequency thermocoagulation in the treatment of epilepsy caused by focal cortical dysplasia type Ⅱ

目的探讨立体脑电图(SEEG)电极介导的射频热凝(RFTC)治疗局灶性皮质发育不良(FCD)Ⅱ型药物难治性癫痫患者的疗效,并分析其病灶毁损程度与疗效的相关性.方法回顾性分析2017年10月至2021年11月广东三九脑科医院神经外科应用SEEG电极介导RFTC治疗的31例FCDⅡ型药物难治性癫痫患者的临床资料.31例患者的FCD病灶位于额叶13例,中央区17例,顶叶1例.观察毁损术后的并发症及改良Engel分级;癫痫控制疗效以癫痫发作减少程度评估.根据术前头颅MRI液体衰减反转恢复序列和术后头颅MRI 3D T1加权成像,运用MATLAB软件测量各病灶、毁损灶三维模块的体积.将术前FCD病灶与RFTC毁损灶在空间上的重叠部分的体积定义为病灶的有效毁损体积,其占术前FCD病灶的比率即为病灶毁损程度(%).根据病灶毁损程度是否≥40%将患者分为毁损充分组与毁损欠充分组,比较两组患者Engel分级Ⅰ级者的比例.采用Spearman法分析病灶毁损程度与癫痫控制疗效的相关性.结果31例患者的RFTC手术均顺利完成,毁损靶点数[M(Q_(1),Q_(3))]为20(14,26)个.8例病灶位于中央区的患者在RFTC治疗后出现暂时性手术对侧肢体肌力轻度下降.31例患者的随访时间[M(Q_(1),Q_(3))]为38(7,50)个月.至末次随访,Engle分级Ⅰ级17例(54.8%),Ⅱ级3例(9.7%),Ⅲ级6例(19.4%),Ⅳ级5例(16.1%);癫痫发作减少程度[M(Q_(1),Q_(3))]为100%(58%,100%).8例(25.8%)患者因疗效欠佳进一步行病灶及致痫区切除性手术,术后均未再出现癫痫发作.31例患者FCD病灶的体积[M(Q_(1),Q_(3))]为1735(1176,2857)mm^(3).31例患者的毁损灶体积[M(Q_(1),Q_(3))]为1436(1255,2607)mm^(3),有效毁损体积为591(410,932)mm^(3),病灶的毁损程度为37%(30%,57%).Spearman相关分析结果显示,病灶毁损程度与癫痫发作减少程度呈正相关(Spearman相关系数为0.61,P<0.001).与毁损欠充分组(18例)比较,毁损充分组(13例)Engle分级Ⅰ级者占比高(分别为12/13、5/18),差异具有统计学意义(P<0.001).结论通过SEEG电极介导的RFTC治疗FCDⅡ型药物难治性癫痫患者安全、有效;病灶毁损程度较高的患者癫痫控制疗效更佳.

Objective To explore the efficacy of stereoelectroencephalography(SEEG)electrode-mediated radiofrequency thermocoagulation(RFTC)in the treatment of epilepsy caused by focal cortical dysplasia(FCD)typeⅡand the correlation between the degree of damage and the efficacy.Methods The clinical data of 31 patients with drug-refractory epilepsy caused by FCD typeⅡwho were treated with SEEG electrode-mediated RFTC at the Neurosurgery Department of Guangdong Sanjiu Brain Hospital from October 2017 to November 2021 were retrospectively analyzed.The FCD lesions of 31 patients were located in the frontal lobe in 13 cases,the central area in 17 cases,and the parietal lobe in 1 case.The postoperative complications and modified Engel classification were documented.The efficacy of seizure control was evaluated by the degree of seizure frequency reduction.Based on the preoperative head MRI fluid-attenuated inversion recovery(FLAIR)sequence and postoperative head MRI 3D T1-weighted imaging,MATLAB software was used to measure the volume of the three-dimensional module of each lesion and damaged lesion.The volume of the spatial overlap between preoperative FCD lesions and post-RFTC damaged lesions was defined as the effective damaged volume of the lesions,and its ratio to the preoperative FCD lesions was the degree of lesion damage.Patients were divided into sufficiently damaged group and insufficiently damaged group according to whether the degree of lesion damage was≥40%,and the proportion of Engel gradeⅠpatients in the two groups was compared.The Spearman method was used to analyze the correlation between the degree of lesion damage and the efficacy of seizure control.Results The RFTC surgeries of 31 patients were successfully completed,and the number of damaged targets[M(Q_(1),Q_(3))]was 20(14,26).Eight patients with lesions located in the central area experienced temporary mild decrease in muscle strength of the contralateral limb after RFTC treatment.The follow-up time[M(Q_(1),Q_(3))]of 31 patients was 38(7,50)months.As of the last follow-up,there were 17 cases(54.8%)of Engle classification gradeⅠ,3 cases(9.7%)of gradeⅡ,6 cases(19.4%)of gradeⅢ,and 5 cases(16.1%)of gradeⅣ.The degree of seizure frequency reduction[M(Q_(1),Q_(3))]was 100%(58%,100%).Eight patients(25.8%)underwent further surgery for resection of lesions and epileptogenic zones due to poor efficacy,and no recurrence occurred after surgery.The volume of FCD lesions[M(Q_(1),Q_(3))]in 31 patients was 1735(1176,2857)mm^(3).The volume of damaged lesions[M(Q_(1),Q_(3))]in 31 patients was 1436(1255,2607)mm^(3).The effective damage volume was 591(410,932)mm^(3).The damage degree of the lesion was 37%(30%,57%).Spearman correlation analysis results showed that the degree of lesion damage was positively correlated with the degree of seizure frequency reduction(Spearman correlation coefficient:0.61,P<0.001).Compared with the insufficiently damaged group(18 cases),the sufficiently damaged group(13 cases)had a higher proportion of Engle gradeⅠpatients(12/13 vs.5/18),and the difference was statistically significant(P<0.001).Conclusions RFTC mediated by SEEG electrodes is safe and effective in the treatment of epilepsy caused by FCD typeⅡ.Patients with higher degree of lesion damage have better seizure control efficacy.