CAJ | 학술논문

目的观察应用脑立体定向微创穿刺技术植入海马电极监测颞叶内侧癫痫的效果.方法 13例耐药性颞叶内侧癫痫患者,主要表现为复杂部分性癫痫发作及继发性全身强直阵挛性发作.根据临床症状、MRI等资料初步确定癫痫灶位于海马区域,在脑立体定向仪引导下于双侧海马植入8-触点深部电极,监测24 ～ 72 h,从而确认癫痫灶是否位于海马区域.结果 13例患者经过72 h监测,共监测到7例有29次临床发作,发作期脑电变化表现为在背景波形基础上出现阵发性高幅慢波或棘尖慢复合波,从某个电极点开始,迅速扩展到同侧其他电极点甚至对侧电极;头皮脑电在延迟1～2s后出现3～4 Hz的高幅δ节律.6例未监测到临床发作的患者,海马电极监测到发作性局灶性高幅慢波或尖慢综合波,而头皮电极未监测到明显异常.13例患者中6例接受选择性海马杏仁核切除或立体定向病灶损毁术,随访3～8个月,效果满意.结论脑立体定向植入海马电极监测颞叶内侧癫痫是一种安全可靠的方法,可以判断癫痫病灶的起源,为外科进行选择性海马杏仁核切除提供有力依据,对于视频脑电图或其他手段难以记录到癫痫样波形或难以判断癫痫样放电起源的患者可进行脑立体定向深部电极脑电图监测.
목적 관찰응용뇌입체정향미창천자기술식입해마전겁감측섭협내측전간적효과.방법 13례내약성섭협내측전간환자,주요표현위복잡부분성전간발작급계발성전신강직진련성발작.근거림상증상、MRI등자료초보학정전간조위우해마구역,재뇌입체정향의인도하우쌍측해마식입8-촉점심부전겁,감측24 ～ 72 h,종이학인전간조시부위우해마구역.결과 13례환자경과72 h감측,공감측도7례유29차림상발작,발작기뇌전변화표현위재배경파형기출상출현진발성고폭만파혹극첨만복합파,종모개전겁점개시,신속확전도동측기타전겁점심지대측전겁;두피뇌전재연지1～2s후출현3～4 Hz적고폭δ절률.6례미감측도림상발작적환자,해마전겁감측도발작성국조성고폭만파혹첨만종합파,이두피전겁미감측도명현이상.13례환자중6례접수선택성해마행인핵절제혹입체정향병조손훼술,수방3～8개월,효과만의.결론 뇌입체정향식입해마전겁감측섭협내측전간시일충안전가고적방법,가이판단전간병조적기원,위외과진행선택성해마행인핵절제제공유력의거,대우시빈뇌전도혹기타수단난이기록도전간양파형혹난이판단전간양방전기원적환자가진행뇌입체정향심부전겁뇌전도감측.
Objective To observe the effects of stereotactic implanting depth electrode into the hippocampus on monitoring mesial temporal lobe epilepsy. Methods Thirteen patients with pharmacoresistant epilepsy were included in the present study.The epilcptogenic zone might be located in the hippocampus based on the symptoms and MRI data.Eight-contact depth electrode was implanted into the patients' hippocampus by stereotactic procedures to record the electroencephalogram(EEG).The duration of monitoring lasted for 24-72 hours or more,so as to be sure if the epileptogenic zone was located in the hippocampus,and to provide evidences for surgical resection of epileptic focus.Results Thirteen patients with mesial temporal lobe epilepsy underwent video electroencephalogram monitoring for 72 hours.Twentynine epileptic seizures in 7 patients were detected.Ictal EEG changes manifested as paroxysmal slow wave or spike and slow waves on the background.The epileptiform discharges started from some electrode points,and then propagated to others or the contralateral electrode. After 1-2 seconds of delay,high amplitude slow waves with the frequency of 3-4 Hz were observed on the ipsilateral scalp EEG. Clinical epileptic seizures were not detected in 6 patients during monitoring,depth electrode showed paroxysmal focal high amplitude slow wave or spike and sharp waves,scalp EEG did not find abnormality.Six of thirteen patients received surgical resection of epileptic foci,the outcome during follow-up of 3-8 months was satisfactory.Conclusions To record hippocampal EEG in patients with intractable epilepsy by stereotactic implanting depth electrode into the hippocampus might be a safe and reliable method.It might provide strong evidences for the diagnosis of patients with mesial temporal lobe epilepsy,and for the location of epilcptogenic zone.