CAJ | 학술논문

目的评价采用立体定向联合术中皮层脑电图(ECoG)、神经电生理监测(IOM)治疗功能区皮层下小肿瘤性癫痫的手术方法及效果、并发症. 方法解放军第153医院神经外科自2006年6月至2011年6月共收治功能区皮层下小肿瘤引起的癫痫患者15例,均在立体定向仪导向下,开放直视手术准确切除肿瘤,ECoG监测定位致痫灶,IOM判断致痫灶与功能区的重叠程度,分别采取切除术、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.总结分析患者的手术方法及疗效. 结果本组肿瘤全切13例,次全切2例；瘤周致痫灶切除4例,瘤周致痫灶MST或/和皮层低功率电凝热灼术11例;术毕ECoG监测发现痫样放电消失、基本节律大致恢复正常6例,仍残留少量棘波6例,残存较多棘波且基本节律轻到中度异常3例;无严重永久性并发症；随访1～3年,肿瘤原位复发2例,Engel分级Ⅰ级10例,Ⅱ级3例,Ⅲ级2例,总有效率100％.结论立体定向联合术中ECoG、IOM治疗功能区皮层下小肿瘤性癫痫,能够精准定位并切除肿瘤及处理致痫灶,避免损伤功能区,是一种微创、安全、有效的手术方法.
목적 평개채용입체정향연합술중피층뇌전도(ECoG)、신경전생리감측(IOM)치료공능구피층하소종류성전간적수술방법급효과、병발증. 방법 해방군제153의원신경외과자2006년6월지2011년6월공수치공능구피층하소종류인기적전간환자15례,균재입체정향의도향하,개방직시수술준학절제종류,ECoG감측정위치간조,IOM판단치간조여공능구적중첩정도,분별채취절제술、다처연막하횡절술(MST)혹피층저공솔전응열작술처리치간조.총결분석환자적수술방법급료효. 결과 본조종류전절13례,차전절2례；류주치간조절제4례,류주치간조MST혹/화피층저공솔전응열작술11례;술필ECoG감측발현간양방전소실、기본절률대치회복정상6례,잉잔류소량극파6례,잔존교다극파차기본절률경도중도이상3례;무엄중영구성병발증；수방1～3년,종류원위복발2례,Engel분급Ⅰ급10례,Ⅱ급3례,Ⅲ급2례,총유효솔100％.결론 입체정향연합술중ECoG、IOM치료공능구피층하소종류성전간,능구정준정위병절제종류급처리치간조,피면손상공능구,시일충미창、안전、유효적수술방법.
Objective To investigate the efficiency and complications of stereotactic surgery combined with intra-operative electrocorticography (ECoG) and intra-operative neurophysiologic monitoring (IOM) in treating epilepsy secondary to subcortex small tumors in the functional areas.Methods Fifteen patients with epilepsy secondary to subcortex small tumors in the functional areas,admitted to our hospital from June 2006 to June 2011, were chosen in our study. Resection was performed to these tumors. Guiding with stereotaxic apparatus, epileptogenic foci and boundary localizing by intra-operative ECoG monitoring,functional areas and neuronal structures in the epileptic region judging by IOM,the epileptogenic foci were resected or performed multiple subpial wansaction (MST) and/or cortices lower output powers thermocoagulation.The treatment efficacy was concluded.Results Total resection was achieved in 13 patients and subtotal resection in 2.Epileptogenic foei were ablated in 4 patients,and peri-lesioned cortex of epileptogenic foci in other 11 patients were performed lower output powers thermocoagulation or/and MST. ECoG monitoring found epileptiform discharge disappearance in 6 patients,residual of a few spikes in 6,residual of a lot of spikes as well as having mild to moderate abnormal basilic rhythms in EEG in 3.No permanent and severe complications were noted.All patients were followed up for 1 to 3 y; tumor recurrence was noted in 2; according to Engel's classification standards,Engel I was noted in 10,Engel Ⅱin 3 and Engel Ⅲ in 2,and the effective rate was 100％. Conclusion Stereotactic surgery combined with intra-operative ECoG and IOM is a safe,effective and microinvasive management for epilepsy secondary to subcortex small tumor in the functional areas; it can accuratly locate and totally resect the tumors,treating the epileptogenic foci and avoiding functional defects.