顽固性癫痫的精确定位和微创手术治疗

Three dimensional localization of refractory epilepsy focus and its minimally invasive surgery

目的 提高药物难治性癫痫的致痫灶精确定位和外科治疗水平。方法 综合应用三维痫灶精确定位诊疗计划系统及影像学检查对185例顽固性癫痫患者进行术前、术中致痫灶三维精确定位,采用癫痫外科微创手术技术(神经导航技术、多处软膜下扇形横切、胼胝体潜行切开等技术)毁损致痫灶、阻断致痫网以治疗药物难治性癫痫。结果 将术前“偶极子”系统定位结果与术中64导皮层电极及8导深部电极检测结果相比较,证实该定位系统定位准确可靠;必要的影像学检查有助于痫灶定性定位诊断及治疗方案设计;随访疗效评估显效率达到87.0％,总有效率达到94.6％,术后正常神经功能保持良好,无明显后遗症。结论 综合应用三维痫灶精确定位诊疗计划系统和影象学检查定位及癫痫外科微创手术技术是外科治疗顽固性癫痫的较好方法。

Objective To improve localization of refractory epilepsy foci and its minimally invasive surgery. Methods Epilepsy focus was precisely located by three dimensional localization diagnosis and treatment system and imaging examination in 185 cases of refractory epilepsy before and during operation. Epilepsy focus and epilepsy net were destroyed or interdicted with minimally invasive surgery. Results This system was confirmed to be accurate in the localization and detection of 64 channels ECoG and 8 channels depth elector at operation, with imaging examination helpful for localization. 1-2 years after operation, apparent efficacy rate and total efficacy rate were 87.0 % and 94.1 % respectively. Conclusion Epilepsy focus located by three dimensional localization system combined with image examination and minimal invasive surgery is promising in the surgical treatment of refractory epilepsy.