摘要
目的通过术中皮层脑电图(ECoG)与长程颅内电极定位致痫灶一致性的对比研究,探讨癫痫外科治疗中应用 ECoG 定位致痫灶的意义。方法回顾性研究2005年4月至2006年8月,我们收治的22例术前采用长程颅内电极监测,术后病理证实为局灶性皮质发育不良患者的临床资料。应用统计学方法分析术前长程颅内 EEG 中发作间期异常放电(IED)小现的频率、波幅与发作期异常放电(ID)之间的相互关系,及其与术中 ECoG 监测结果的比较。结果长程颅内 EEG 中,ID 起源点与非起源点之间 IED 的标准化频率有显著性差异(Z=12.213,P<0.001),将标准化的 IED 频率作为 ID 点的判定指标,获得 ROC 曲线下的面积为0.758(95%CI,0.707～0.810)。起源点与非起源点之间 IED 的波幅有显著性差异(Z=11.765,P<0.001)。术中 ECoG 监测的 IED 频率显著低于长程监测(rho=0.518,P=0.014)。ECoG 中"频发"(≥10次/min)与"常发"(3～10次/min)组中 IED的频率与波幅特点及其与 ID 部位之间的关系与长程监测结果相似;在"少发"(≤3次/min)组中这种相似性差(rho=0.408,P=0.147)。结论长程颅内 EEG 临测中应用 IED 判定 ID 具有中等意义诊断价值。与长程颅内 EEG 监测相比,ECoG 监测的 IED 频率明显减少。当 ECoG 中 IED 频率为"频发"与"常发"时,其 IED 的频率与波幅分布规律以及与 ID 之间的关系与术前长程 EEG 监测结果相似,其 IED 的特点可以作为提示 ID 的参考并指导定位致痫灶。
Objective To discuss the localizing methods for epileptiogenic zone with intraoperative electrocorticography （ECoG） by comparing it with long-term intracranial EEG. Methods Twenty-two patients was enrolled, who received epilepsy surgeries consecutively in our institute since April 2005 to August 2006. All patients underwent intracranial electrode implantations with long-term video-EEG monitoring before the resective surgeries and the postoperative pathologies were all proved to be focal cortical dysplasia. The extra-operative and ECoG digital EEGs were statistically analyzed and compared with each other, including interictal epileptifrom discharge （lED） frequency, amplitude and their correlations with ictal discharge （ID）. Results In the long-term intracranial EEG, significant difference was found between lED frequency derived from ID onset verus none-onset electrodes （Z = 12. 213, P 〈0. 001 ）, ROC analysis showed that lED frequency is a moderately good indicator for ID, the area under the ROC curve was 0. 758 （95% CI, 0. 707-0. 810）. There was significant difference in lED amplitude between ID and none-ID electrodes （Z = 11. 765, P 〈0. 001 ）. The lED frequency was significantly lower during ECoG than during long-term extra-operative monitoring （ rho = 0. 518, P = 0. 014）. A significant positive correlation in the lED frequency pattern was found between intra-operative ECoG and extra-operative recording when the average lED frequency was over 3 spikes /min. In ECoG, the correlation of lED with ID was similar in the ‘ frequent＇ （ 1〉 10 spikes/min） and ‘occasional＇ （3-10 spikes/min）groups and very different in the ‘rare＇ （ ≤3 spikes/min） group（rho =0. 408, P =0. 147）. Conclusions The lED from long-term EEG recording had moderate correlationship in frequency and amplitude with ID position, lED frequency was usually decreased on ECoG when compared with long term monitoring. However, ECoG could reliably reflect the lED pattern and the correlations between
出处
《中华外科杂志》
CAS
CSCD
北大核心
2007年第24期1672-1675,共4页
Chinese Journal of Surgery
关键词
癫痫
外科手术
术中皮层脑电监测
致痫灶
Epilepsy
Surgical procedures, operative
Electrocorticography
Epileptogenic zone
