皮层脑电图监测下外科治疗继发性癫痫

发布时间：2018-06-21 05:24

  本文选题：皮层脑电图 + 继发性癫痫　； 参考：《兰州大学》2014年硕士论文

【摘要】：目的：探讨皮层脑电图监测下继发性癫痫的外科治疗方法及疗效。 方法：对40例继发性癫痫患者术前行常规脑电图、长程视频脑电图检查,并联合CT.MRI或者fMRI.MRS等影像学检查结果及临床表现综合分析,初步确定致痫灶的部位及范围。术中通过皮层脑电图定位致痫灶,显微手术切除原发病灶后,再根据皮层脑电监测结果、癫痫发作的临床表现、病灶部位决定进行致痫灶切除、皮层热灼、多处软膜下横纤维切断、前颞叶切除、杏仁核海马切除及胼胝体前部切开术等；术后常规应用抗癫痫药物并随访。 结果：40例患者术前头皮脑电图检查,其中33例显示癫痫波放电部位与影像学病变部位符合或相近,6例显示广泛痫性放电,1例未发现癫痫波。切除病灶前均通过皮层脑电图监测到癫痫波,切除原发病变后再次皮层脑电图监测病变周围皮质可记录到异常致痫波28例,占70%。其中22例位于重要功能区或与之相近,采用皮层热灼或软膜下横切后,20例癫痫波消失,剩余2例患者行选择性海马-杏仁核切除和胼胝体前部切开,皮层脑电图监测示痫性波显著减少；另有6例位于非功能区,切除痫性放电区域的皮质,再行皮层脑电图监测痫性波消失,手术效果满意。术后随访3-18个月,根据Engel标准评判疗效,EngelⅠ级：29例(72.5%)；Ⅱ级：7例(17.5%)；Ⅲ级：3例(7.5%)；Ⅳ级：1例(2.5%)。总有效者39例,有效率为97.5%。 结论：在完全切除原发病灶后,术中运用皮层脑电图监测,可以定位原发病灶以外的致痫灶及重要功能区,指导手术中准确切除致痫灶最大限度保留神经功能,预测手术疗效,明显提高手术治疗的有效性。
[Abstract]:Objective: to investigate the surgical treatment and curative effect of secondary epilepsy under cortical electroencephalogram monitoring. Methods: 40 patients with secondary epilepsy were examined by routine EEG and long range video EEG before operation, and combined with CT. MRI or fMRI.MRS, the location and range of epileptogenic foci were preliminarily determined. The epileptogenic foci were located by electrocortical electroencephalogram (EEG) during the operation. After the primary lesions were resected by microsurgery, according to the results of cortical EEG monitoring, the location of epileptic seizures was determined by resection of epileptogenic foci and cauterization of cortical heat. Multiple subpial transection, anterior temporal lobectomy, hippocampal resection of amygdaloid nucleus and anterior corpus callosum were performed, and antiepileptic drugs were routinely used and followed up. Results electroencephalogram of scalp was examined in 40 patients before operation, of which 33 cases showed epileptic wave discharge site in accordance with or similar to imaging lesion location. 6 cases showed extensive epileptic discharge in 1 case and no epileptic wave was found in 1 case. Epileptic waves were detected by cortical electroencephalogram (EEG) before excision, and abnormal epileptic waves were recorded in 28 cases (70%) by cortical electroencephalogram (EEG) monitoring again after resection of primary lesions. Among them, 22 cases were located in or close to the important functional area, 20 cases of epileptic wave disappeared after cortical cauterization or subpial transection, the remaining 2 cases underwent selective hippocampal amygdaloidectomy and anterior callosum incision. Electrocortical electroencephalogram (EEG) was used to monitor the disappearance of epileptic wave, and 6 cases were located in the non-functional area, the cortex was excised from the epileptic discharge area, and the operative effect was satisfactory. The follow-up period was 3-18 months. According to the Engel criterion, 29 cases of Engel 鈪，

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