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目的评价采用多种致痫灶定位方法联合手术治疗难治性继发性癫痫的效果、并发症、适应证。方法 196例继发性癫痫患者,通过影像学检查、视频脑电图监测(VEEG)、癫痫发作症状学特点、正电子发射断层扫描(PET-CT)检查等方法综合判断致痫灶位置,术中皮层脑电图(ECoG)监测确定致痫灶的范围、神经电生理监测(IOM)定位功能区,辅助以麻醉唤醒定位语言区、实时超声检查病变切除程度、立体定向引导定位脑深部小病灶,根据监测结果分别采取病变组织切除及致痫灶切除术、多处软膜下横切术(MST)或皮层低功率电凝热灼术处理致痫灶。结果 ECoG基本正常,行单纯病灶切除术29例;ECoG明显异常,在非功能区51例,行病灶+周边致痫皮层切除术;ECoG明显异常而又在功能区79例,行病灶+功能区致痫皮层MST或低功率电凝热灼术;深部电极监测发现杏仁核或海马异常放电37例,行前颞叶及杏仁核、海马切除术;辅助胼胝体前部切开术19例。术毕ECoG监测发现痫样放电消失、基本节律大致恢复正常76例,仍残留少量棘波48例,残存较多棘波且基本节律轻到中度异常43例。随访0.5~7.5年,有效随访177例,EngelⅠ级103例,EngelⅡ级45例,EngelⅢ级19例,EngelⅣ10例。总有效率94.3%。结论综合应用多种定位方法联合手术治疗继发性癫痫,能够准确定位并切除病灶及处理致痫灶,避免损伤功能区,是一种安全、有效的方法。
Objective To evaluate the effects, complications and indications of refractory secondary epilepsy by using multiple methods of targeting epileptic foci. Methods A total of 196 patients with epilepsy were enrolled in this study. The location of epileptogenic foci was evaluated by means of imaging examination, video-electroencephalogram monitoring (VEEG), seizure symptoms and positron emission tomography (PET-CT) The area of epileptogenic zone was identified by ECoG monitoring. Functional areas of neuroelectrophysiological monitoring (IOM) were located. Arousal was used to locate the language area. Real-time ultrasonography was performed to detect the extent of lesion. Stereotactic orientation was used to guide the localization of small deep brain lesions , According to the results of the monitoring were taken to lesion resection and epileptogenic resection, multiple subtotal transection (MST) or cortical hypothermic electrocoagulation treatment of epileptogenic lesions. The results ECoG basically normal, simple resection of the tumor in 29 cases; ECoG significantly abnormal in 51 cases of non-functional area, the line of peripheral lesions + epileptic cortex resection; ECoG significantly abnormal and in the functional area in 79 cases, the lesion + functional area Epileptic cortex MST or low-power electrocautery cauterization; deep electrode monitoring found that 37 cases of abnormal amygdala or hippocampus discharge, anterior temporal lobes and amygdala, resection of the hippocampus; assisted anterior incision of the corpus callosum in 19 cases. ECoG monitoring found epileptiform discharge disappeared, the basic rhythm roughly returned to normal in 76 cases, still a small number of spikes in 48 cases, remaining more spikes and the basic rhythm mild to moderate abnormalities in 43 cases. The follow-up ranged from 0.5 to 7.5 years. There were 177 effective follow-up cases. There were 103 cases of EngelⅠ, 45 cases of EngelⅡ, 19 cases of EngelⅢ and 10 cases of EngelⅣ. The total efficiency of 94.3%. Conclusion Combined application of multiple positioning methods combined with surgical treatment of secondary epilepsy is a safe and effective method to accurately locate and remove the lesion and treat the epileptic foci to avoid damage to the functional area.