【摘要】 目的探析药物难治性癫痫患者应用立体定向脑电图(SEEG)引导下射频热凝毁损术治疗的效果。方法将我院2015年3月~2016年3月间收治的12例药物难治性癫痫患者纳为研究对象,经多学科专家对其术前无创性影像学检查结果进行分析,制定SEEG电极植入计划,后行SEEG电极置入技术定位致病灶,根据致病灶结果进行射频热凝毁损术治疗,观察其治疗效果。结果在SEEG引导下,分别在12例药物难治性癫痫患者大脑中置入6~12个电极,平均埋藏天数(7.84±1.36)d,置入期间并未出现脑脊液外渗、电极诊断等严重不良事件,SEEG记录显示,12例患者中,有1例定位于双侧,未行手术治疗,其余11例均准确定位致痫灶,其中3例定位左颞叶,其余8例多为脑叶或深部致病灶起始,11例患者均根据SEEG显示的发作起始区域进行射频热凝毁损术治疗,射频毁损靶点数目4~11个不等,治疗后随访6~12个月,平均(8.23±2.03)个月,仅两名患者因情绪激动、过度体力劳动各复发1次。结论 SEEG可准确定位致痫网络,置入后并发症率更低,利于长时间监测,在SEEG引导下行射频热凝毁损术可有效清除致痫灶,减轻患者痛苦。更多还原

【Abstract】 Objective To explore the effects of radiofrequency thermocoagulation guided by stereotactic electroencephalogram(SEEG) in 12 patients with medically intractable epilepsy. Methods Twelve patients with medically intractable epilepsy treated in our hospital from March 2015 to March 2016 were selected for the study. The results of noninvasive preoperative imaging examination were analyzed by the multidisciplinary experts, and SEEG electrode implantation plan was developed, followed by SEEG electrode placement technology to locate lesions. And the radiofrequency thermocoagulation was made according to lesions results, and the treatment effects were observed. Results The 6-12 electrodes were implanted into the brain of 12 patients with medically intractable epilepsy under SEEG guidance, with mean burial days of(7.84±1.36) days, and there was no serious cerebrospinal fluid leakage, electrode diagnosis and other serious adverse events during implantation. SEEG records showed that there was 1 case located in both sides without surgical treatment among 12 cases, and the remaining 11 cases were with accurate positioning of epileptogenic lesions(3 cases located in the left temporal lobe, and 8 cases mostly lobar or deep induced lesion onset), and the 11 cases were treated with radiofrequency thermocoagulation according to the onset starting area shown by SEEG. The number of target sites for radiofrequency thermocoagulation ranged from 4 to 11, and patients were followed up for 6 to 12 months after treatment with mean(8.23±2.03) months. Only two patients relapsed due to emotional agitation or over manual labor respectively. Conclusion SEEG can accurately locate epilepsy network, and it has lower complications rate after implantation and can benefit long-term monitoring, and SEEG guided radiofrequency thermocoagulation can effectively remove epileptogenic lesions, relieve the sufferings of the patients.更多还原