【摘要】 目的探讨正电子发射断层扫描(PET)对难治性癫痫的定位价值,评价γ-刀治疗难治性癫痫的效果及脑电图改变。方法43例患者主要依据PET显像,结合癫痫发作特点、EEG、MRI等检查综合定位致痫灶,应用MASEP-SRRS型旋转式γ-刀治疗,单纯性致痫灶照射边缘剂量为9～14Gy,等中心曲线40%～60%。需加照射杏仁核和海马时,边缘剂量25～30Gy;照射胼胝体时中心剂量75～100Gy,均为50%等剂量曲线。随访3～36个月,观察发作频率、脑电图变化情况,评价治疗效果。结果43例患者中,39例(90.7%)为发作间期的PET图像,表现皮层局限性低代谢灶,其中单发灶33例(84.6%),多发灶6例(15.4%);4例(9.3%)为发作期的PET图像,表现皮层单发的局限性高代谢灶;异常代谢灶常见于颞叶,其次为额叶。发作频率术前5.2±2.6次/月,术后12个月降至1.3±0.9次/月,随访结束时降至0.9次/月左右,与治疗前相比差异具有显著性意义(P<0.01)。对随访6～36个月的病人进行Wieser疗效评定,Ⅰ～Ⅱ级为31.4%～38.9%,Ⅲ～Ⅳ级为43.6%～51.4%,Ⅴ～Ⅵ级为15.3%～23.1%,其中Ⅰ～Ⅳ级(有效率)为76.9%～84.6%。EEG逐渐恢复正常为7.7%～16.7%,53.8%～62.9%好转,22.2%～38.5%无变化,好转率61.5%～77.8%。主要并发症为放射性脑水肿,发生率为16.7%,经对症治疗后均能缓解。结论PET辅助定位下,低剂量γ-刀治疗顽固性癫痫具有较高的有效率,无严重并发症,是一种有效的癫痫微侵袭外科治疗方法;采用9～14Gy的周边剂量照射PET提示的致痫灶可取得良好效果。更多还原

【Abstract】 Objective To discuss the clinical value of 18F-Fluorodeoxyglucose(18F-FDG)PET cerebral imaging in focus localization of patients with intractable epilepsy,and evaluate the clinical effect in intractable epilepsy treatred by gamma knife with sublesion-dose.Methods PET examination based on 18F-Fluorodeoxyglucose(18F-FDG)was carried out in 43 patients in order to localize epileptogenic foci,and the treatment target was comfirmed by the combination of CT,MRI,AEEG,Clinical manifestation,according to the results of examination.The treatment outcomes of 43 patients with intractable epilepsy treated by Masep-SRRS Gamma Knife were retrospectively analyzed.Peripheral radiation dose of 9～14 Gy to isodose line of 40%～60% was managed when target was pointed to the epileptogenic focus,and 25～30 Gy to 50% was managed to the homolateral amygdala and hippocampus if necessary,and 38～50 Gy to 50% was managed to the callosum if necessary.The follow-up time were 3～36 months.The seizure frequency of epilepsy and was recorded to evaluate the therapeutic effect.Results In interictal PET images,39 patients(90.7%)showed focal hypometabolism,single focus 33 cases,multiple focus 6 cases.4 patients(9.3%)showed focal hypermetabolism.The seizure frequency declined from(5.2±2.6)times permonth before gamma knife permonth(1.3±0.9)times permonth 12 months after treatment,and 0.9 permonth till the end of the follow-up.The follow-up time were 6～36 months.31.4%～38.9% was classified as Wieser grades Ⅰand Ⅱ,which were regarded as cured,43.6%～51.4% as grades Ⅲ and Ⅳ,as effective,and 15.3%～23.1% as grades Ⅴ and Ⅵ,as ineffective.According to EEG follow-up data,there were 7.7%～16.7% with normal recording,53.8%～62.9% with improving recording,22.2%～38.5% with no change of recording.The main complication was radiation-induced cerebral edema with an incidence rate of 16.7%,and relieved after symptomatic treatment.Conclusion Stereotactic gamma knife treatment with low radiation dose under the guidance of PET provides a safe,effective and minimally invasive surgical approach for patients with intractable epilepsy,and peripheral radiation doses of 9 to 14 Gy for the epileptic foci localized by PET is sufficient to ensure good clinical outcome.更多还原