摘要
目的探讨术中皮层脑电图（ECoG）监测下继发性癫痫的手术治疗效果。方法选择自2004年9月至2008年1月贵州省人民医院收治的84例继发性癫痫患者行手术治疗，术中通过ECoG定位癫痫灶，显微手术切除原发病变，再根据癫痫发作的临床表现、病灶部位及ECoG监测所提示的异常脑电图波释放情况决定是否进行致痫灶切除及扩大致痫灶切除术，皮层热灼术．前颞叶切除术，海马、杏仁核切除术，胼胝体前部切开术。结果84例患者切除病变前ECoG均可记录到癫痫波，原发病变切除后即时ECoG监测病变周围可记录到异常癫痫波80例，检出率为95．24％。其中13例致痫波发放区域位于非功能区者对该范围内皮层予以完全切除，术后即时ECoG提示癫痫波消失。67例位于或毗邻重要功能区者，采用低功率热灼该处皮层后，60例癫痫波消失。7例患者经联合胼胝体前部切开和（或）海马、杏仁核切除，术后即时ECoG监测效果满意。术后随访10个月～4年，按Engle标准评定疗效：Ⅰ级56例（66．67％），Ⅱ级21例（25．00％），Ⅲ级4例（4．76％），Ⅳ级3例（3．57％1；手术总有效率为96．42％。结论ECoG监测可明显提高手术治疗继发性癫痫的效果。
Objective To investigate the therapeutic effect of surgical management on patients with secondary epilepsy under the monitoring of cortical electrocorticography （ECoG）. Methods Eighty-four patients with secondary epilepsy, admitted to our hospital from September 2004 to January 2008, were chosen; intraoperative ECoG monitoring was performed to locate the epileptic foci before the resection of the primary lesion. After the resection of primary lesion, resection of epileptic loci, enlarged resection of epileptic foci, cortical thermocoagulation, anterior temporal lobectomy, amygdalohippocampectomy and anterior callosotomy were performed, respectively, in different patients according to the clinical manifestations of seizures, and the locations of lesions and epileptic waveform discharges detected by intraoperative ECoG monitoring. Results The epileptic waveform discharges in 84 patients were noted before the resection of primary lesion. The epileptic waves were found in 80 patients at the peripheral areas of the primary nidus under immediately postoperative ECoG monitoring, with a relevance ratio reaching 95.24%; after the resection of residual cortical zone with epileptic wave discharges, epileptic wave disappeared on immediately postoperative ECoG in 13 patients whose lesion located in nonfunctional area; normal signals were noted in 60 of the 67 patients performed cortical thermocoagulation whose cortical zone with epileptic wave discharges were located or neighbored in fimctional area, and good outcomes under the immediately postoperative ECoG monitoring were noted in the other 7 patients performed thermocoagulation amygdalohippocampectomy. The follow-up studies for patients （66.67%）, grade II in 21 （25.00%）, grade III in 4 the Engle standard of curative effect were achieved; the combined with anterior callosotomy and/or 10 months to 4 years showed that grade I in 56 （4.76%） and grade IV in 3 （3.57%） according to total effective rate was 96. 42%. ConclusionECoG monitoring can significantly i
出处
《中华神经医学杂志》
CAS
CSCD
北大核心
2011年第4期331-333,共3页
Chinese Journal of Neuromedicine
关键词
癫痫
皮层脑电图
神经外科手术
Epilepsy
Cortical electrocorticography
Surgical management
