皮层脑电图在颅脑病变伴发癫痫术中监测研究

Monitoring of cortical EEG during operation on cranial diseases with epilepsy

目的 总结术中皮层脑电图 (ECoG)用于继发性癫痫外科治疗的临床经验。方法 通过术中皮层脑电图监测 ,对原发灶切除结合外周皮层电灼的方法 ,治疗的 16 5例继发性癫痫病例 (其中胶质瘤 2 0例 ,动静脉畸形2 1例 ,转移癌 12例 ,脑膜瘤 4 5例 ,其它脑部疾患继发性癫痫 6 7例 )的观察 ,分析ECoG在继发性癫痫手术中的意义。结果 其中 15 2例在原发灶外周监测发现棘波 (占 92 .1% ) ,切除原发灶及电灼皮层后 14 7例棘波完全消失或明显减少 (占 96 7% ) ,术后复查常规脑电图 (EEG)显示手术有效率为 84 2 %。结论 对于颅脑占位性病变合并的继发性癫痫 ,单纯切除原发灶并不能完全消除癫痫灶 。

Objective To conclude the clinical experiences of monitoring of EcoG at epileptic surgery.Methods In 4 years,165 patients who are secondary epilepsies have been performed by the method that original lesions were resected and peripheral cortices were fulgurated by bipolar according to ECoG. During these patients, there were 20 gliomas,21 arteriovenous malformations,12 metastatic carcinomas, 45 meningiomas and 67 other cerebral lesions. Result In 152 patients(91.2%),the epileptic waves were detected in the surrounding of original lesions. After the primary lesions were resected and peripheral cortices were fulgurated, spike waves disappeared in 135 patients (88.8%).When EEG is rechecked after surgery, the ratio of validity is 84.2%.Conclusion For the space occupying lesions accompanied by secondary epilepsy, the only resection of original lesions can not completely eliminate epilepsy. The monitoring of ECoG at surgery is necessary for the surgeries of these diseases.