摘要
目的讨论术中脑电监测在癫痫手术中的应用意义。方法40例难治性癫痫患者,术中采用日本光电9200脑电描记系统,应用皮层电极,在致痫灶靶区皮层,对癫痫起源部位进一步精确定位,手术切除致痫灶,并在皮层脑电图(ECoG)监测下进行病灶扩大切除、胼胝体切开或多处软膜下横切(MST),术后常规应用抗癫痫药物。结果全部患者在预定的癫痫灶局部均可记录到癫痫波;病变及癫痫灶切除后即时检测,显示痫性放电明显减少24例,其中3例非功能区海绵状血管瘤,瘤体切除后仍可见大量棘波,扩大切除周围皮质,棘波显著减少;3例功能区胶质瘤患者虽经MST后,棘波有一定改善,仍可见一定量棘波;12例海马硬化及1例海马萎缩术后,仍存在一定量棘波。术后疗效评价,按照Engel分级评价为:Ⅰ级27例,Ⅱ级6例,Ⅲ级4例,Ⅳ级3例;总有效者37例,有效率达92.5%。结论在癫痫手术中运用脑电监测,可以进一步精确定位致痫灶,指导手术中正确切除癫痫灶及预示手术效果,有助于提高手术治疗的有效性,在癫痫外科治疗中具有一定应用价值。
Objective To investigate the application significance of electrocorticography （ECoG） monitoring in surgical treatment of EP （epilepsy）. Methods ECoG monitoring system was used on 40 patients with intractable epilepsy in operation for accurate localization of the epileptogenic zone by detecting the target cortex of the epileptogenic zone with cortical electrodes before operation. Then the epileptogenic focus was removed by using extended ectomy and corpus callosotomy as well as multiple subpial transaction （MST） according ECoG records. Antiepileptic drugs were used after operation. Results Epileptic discharge was obtained from predicated location of epileptngenic zone in all patients by ECoG. Detection at the remove of lesion and epileptogenic zone showed that the epileptic discharge decreased obviously in 24 cases including 3 cases of cavernomas in nonfimctional area where many spike waves could still be found. These spike waves decreased obviously after extended ectomy of cortex around the tumor. Some spike waves still existed in 12 cases of hippocampus indurascent, I cases of hippocainpus atrophy and 3 cases of neurogliocytoma in functional area after operation. According to curative effect assessment of Engel, the clinical outcome showed that 27 patients were seizure free after surgery, 10 patients were improved, and 3 patients were not improved. The effective rate was 92.5% （37/40）. Conclusion ECoG monitoring during operation of EP can be effective in precise localization of epileptogenic zone, direction of the treatment of EP by surgery and forecasting the curative effect.
出处
《中华神经外科疾病研究杂志》
CAS
2007年第6期502-505,共4页
Chinese Journal of Neurosurgical Disease Research
关键词
难治性癫痫
致痫灶
颅内皮层电极
术中脑电监测
Intractable epilepsy
Epileptogenic zone
Cortical electrodes
ECoG monitoring in operation
