ROSA机器人辅助系统引导下的颅内电极植入术在癫痫外科的应用

发布时间：2018-01-09 08:13

  本文关键词：ROSA机器人辅助系统引导下的颅内电极植入术在癫痫外科的应用　出处：《大连医科大学》2017年硕士论文　论文类型：学位论文

  更多相关文章： 癫痫 颅内电极 SEEG ROSA 机器人

【摘要】：目的:通过ROSA机器人辅助系统引导下的颅内电极植入确定致痫灶及皮质功能区指导癫痫外科手术治疗,探讨颅内电极植入的安全性及有效性。方法:回顾性分析沈阳军区总医院神经外科,自2016年8月至2016年12月采用ROSA机器人辅助系统引导下的颅内电极植入的21例药物难治性癫痫患者,21例患者的发作类型主要包括:局灶性发作、全面性发作,临床资料包括:一般病史、实验室检查、神经影像学检查、神经电生理检查、神经心理检查、电极置入后癫痫病灶的检出率、并发症及手术效果。手术过程:术前行神经影像学检查,设计电极植入计划、植入电极、验证电极植入的准确性、记录深部电极脑电图、根据脑电图发作起源定位癫痫灶、手术切除病灶。手术原则:根据病灶部位、术前SEEG监测及皮层电刺激结果,选用不同的手术方式或联合术式,术中应用皮层电极对病灶及其周边检测,进一步确认致痫灶和手术切除区域范围。所有病例术中皮层电极监测致痫灶及其周围记录异常放电。在保全患者重要的皮质功能区的前提下,显微外科手术下行病灶和(或)致痫灶的切除并在皮层脑电图(ECo G)监测下进行病灶。结果:21例患者共植入电极195根,平均约9.2根,电极留置颅内7-35 d,平均13d;捕捉到临床发作2-5次,平均3次。20例患者明确致痫灶,19例患者手术治疗,其中8例患者行颞极、海马及杏仁核切除术,1例行患者性左侧额叶皮质发育不良切除术,1例患者行右侧颞叶皮质发育不良切除及枕叶离断术;1例行左顶叶软化灶及周围致痫灶切除术;1例行右侧额上回、额中回部分皮质及额极切除术;1例行左侧枕叶内侧皮质切除术;1例左侧额叶囊肿及部分前颞叶切除术;1例行顶下小叶及部分颞叶切除;1例行额下回中后部及部分额盖切除术;1例行右侧扣带回中后部切除及胼胝体切开术;1例行右侧额中回后部及部分额上回切除术;1例行右侧缘上回皮层切除及Broca区软膜下横切术。1例患者拒绝手术,1例患者未明确致痫灶,调整药物治疗;并发症:1例患者颅内出血,无神经功能缺失症状,1例患者皮肤感染,未出现死亡、脑脊液漏及电极折断等并发症;19例手术患者中术后随访,发作控制Engel评级I级14例,Ⅱ级2例,Ⅲ级3例,Ⅳ级0例。结论:ROSA机器人引辅助系统引导下的颅内电极植入术,用于药物难治性癫痫的术前评估,准确、安全、病灶检出率高,是一种有效的癫痫灶定位手段。
[Abstract]:Objective: to determine the epileptogenic foci and cortical functional areas under the guidance of ROSA robot assisted system (ROSA) guided intracranial electrode implantation to guide the surgical treatment of epilepsy. To explore the safety and efficacy of intracranial electrode implantation. Methods: the neurosurgery department of Shenyang military region General Hospital was retrospectively analyzed. From August 2016 to December 2016, 21 patients with drug-resistant epilepsy were implanted with intracranial electrodes guided by ROSA robot-assisted system. The attack types of 21 patients mainly included: focal attack, comprehensive attack, clinical data including: general medical history, laboratory examination, neuroimaging examination, neuroelectrophysiological examination, neuropsychological examination. The detection rate, complication and operative effect of epileptic foci after electrode implantation. Operation procedure: preoperative neuroimaging examination, design of electrode implantation plan, electrode implantation to verify the accuracy of electrode implantation. The deep electrode EEG was recorded, the epileptic focus was located according to the origin of EEG, and the lesion was resected. The operative principle: according to the location of the lesion, preoperative SEEG monitoring and cortical electrical stimulation results. Different methods of operation or combined operation were selected, and the cortical electrode was used to detect the lesion and its periphery. Further confirm the scope of epileptogenic focus and surgical resection area. All cases of intraoperative cortical electrode monitoring epileptiform focus and its surrounding records abnormal discharge. While preserving the important cortical functional area of the patient. The lesions and / or epileptogenic foci were resected by microsurgery and monitored by electrocortical electroencephalogram (ECo G). Results 195 electrodes were implanted in 21 patients, with an average of 9.2 electrodes. Electrode indwelling intracranial 7 to 35 days, an average of 13 days; The clinical seizures were captured 2-5 times, with an average of 3 times. 20 patients were diagnosed as epileptic foci. Among them, 8 patients underwent resection of temporal pole, hippocampus and amygdala. One patient had left frontal cortex dysplasia resection and one patient had right temporal cortex dysplasia resection and occipital lobe amputation. One patient underwent resection of left parietal malacia and peripheral epileptic foci. The right superior frontal gyrus, partial cortex of middle frontal gyrus and frontal pole resection were performed in 1 case. Left medial occipital cortex resection was performed in 1 case. One patient had left frontal lobe cyst and partial anterior temporal lobectomy. One patient underwent subparietal lobectomy and partial temporal lobectomy. 1 case of resection of the middle and posterior part of inferior frontal gyrus; The right cingulate gyrus and posterior cingulate gyrus were resected and corpus callosum was cut. One patient underwent resection of the posterior part of the right middle frontal gyrus and part of the superior frontal gyrus. One patient received resection of the right superior edge of the gyrus and 1 patient refused the operation. 1 case did not have definite epileptic foci and adjusted the drug therapy. Complications: 1 case had intracranial hemorrhage, 1 case had no symptoms of neurological loss, 1 case had skin infection, no death, cerebrospinal fluid leakage and electrode breakage, etc. Among the 19 cases of postoperative follow-up, there were 14 cases with Engel grade I, 2 cases with grade 鈪，

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