难治性癫痫的致痫灶定位及手术治疗研究

Study of surgical management and location of intractable epilepsy

目的评价难治性癫痫的致痫灶定位方法和皮层电极监测下致痫灶切除,加行多处软脑膜下横纤维切断术(MST)治疗癫痫的疗效。方法对47例难治性癫痫病人的致痫灶,采用CT+MRI+EEG+单光子发射计算机体层摄影(SPECT)+皮层脑电脑(ECoG)联合检测定位。对检出的阳性病灶在皮层电极监测显微镜下行致痫灶切除,切除后监测仍有癫痫波者加行MST;致痫灶位于重要功能区者单行MST。结果致痫灶阳性检出率86%。皮层电极检测显微镜下致痫灶切除加MST,术后91%的病人癫痫发作停止,半年后约15%的病人复发,但症状较术前减轻,持续时间较术前短。结论CT+MRI+EEG+SPECT+ECoG联合检测,对手术定位具有较高价值。皮层电极监测下致痫灶切除术及MST创伤轻微、效果比较可靠、治愈率高、并发症少、复发率低。病灶及致痫灶的不完全切除和形成皮层软化及疤痕,可能是导致癫痫复发的重要原因。

Objective To evaluate the effect of a new localization mode and the effects of lesionectomy and/or multiple subpial transection(MST)under monitoring of intra-operative ECoG recordings for treatment of intractable epilepsy.Method The localization mode of CT+MRI +EEG+SPECT+ECoG was used in47patients for the sake of increasing the detection rate of the focus of intractable epilepsy.The positive focuses were resected and followed by MST if the localized spike activity still existed after the lesionectomy,both operations were performed under monitoring of intraoperative ECoG recordings.In some functional areas,only MST was performed.Result The epileptogenic focuses were discovered in86%of the patients.91percent of the patients treated with the surgery were seizure free,but 15%of them recurred after6monthes with reduction of seizure frequency and severity.Conclusion The localization mode of CT+MRI +EEG+SPECT+ECoG increased the detection rate of the epileptogenic focus nearly to that detected with PET and had a important localization value in surgery of intractable epilepsy.Lesionectomy and multiple subpial transection(MST)under monitoring of intra-operative ECoG recordings had minimal damage,reliable effect,high rate of seizure free,low rate of complications and recurrence.Incomplete lesionectomy,cortex necrosis,and scar formation might be the causes of recurrence.