CAJ | 학술논문

目的：探讨颅内电极三维重建在涉及脑功能区癫痫术前评估中的应用价值。方法：选择颅内电极植入术的难治性癫痫患者，术前MRI扫描重建脑组织的立体影像。骨瓣开颅电极植入，术中数码拍照，术后头颅CT扫描重建颅内电极。在颅内电极皮层脑电图监测期间，记录癫痫惯常发作起始区；通过慢性电刺激确定皮层功能区。运用图像融合软件将脑组织和颅内电极的三维图像进行融合，形成致痫区与脑功能区的立体虚拟影像。结果：本组共6例患者，男4例，女2例，颅内电极脑电图监测时间平均13．7 d。通过影像三维重建，显示出硬脑膜下电极与其周边脑皮层的毗邻关系，解剖影像清晰，与术中数码照片有较高的一致性，将致痫灶与功能区标注到电极上后，可以显示致痫灶与功能区的空间分布。二期手术后随诊3～6个月，癫痫发作控制良好。结论：颅内电极三维重建能够清晰显示硬膜下电极与脑皮层的空间关系，有利于确定致痫灶与脑功能区的关系，在涉及脑功能区的癫痫术前评估中有较好的应用价值。
목적：탐토로내전겁삼유중건재섭급뇌공능구전간술전평고중적응용개치。방법：선택로내전겁식입술적난치성전간환자，술전MRI소묘중건뇌조직적입체영상。골판개로전겁식입，술중수마박조，술후두로CT소묘중건로내전겁。재로내전겁피층뇌전도감측기간，기록전간관상발작기시구；통과만성전자격학정피층공능구。운용도상융합연건장뇌조직화로내전겁적삼유도상진행융합，형성치간구여뇌공능구적입체허의영상。결과：본조공6례환자，남4례，녀2례，로내전겁뇌전도감측시간평균13．7 d。통과영상삼유중건，현시출경뇌막하전겁여기주변뇌피층적비린관계，해부영상청석，여술중수마조편유교고적일치성，장치간조여공능구표주도전겁상후，가이현시치간조여공능구적공간분포。이기수술후수진3～6개월，전간발작공제량호。결론：로내전겁삼유중건능구청석현시경막하전겁여뇌피층적공간관계，유리우학정치간조여뇌공능구적관계，재섭급뇌공능구적전간술전평고중유교호적응용개치。
Objective Introduce a technique for creating 3-dimensional (3D) brain models of subdural electrodes , ideal for demonstrating the space-relationship of seizure localization and eloquent cortices , and discuss its usefulness for presurgical evaluation of epileptic patients. Methods Patients with medically intractable epilepsy were underwent a thorough preoperative MR brain scan including a T1-weighted high-resolution 3D sequence. Intraoperative photographs were taken with the digital camera. After the surgical implantation of subdural electrodes for epileptic zone localization , the thin-slice CT scan of the electrodes were taken and coregistered to preoperative brain 3D MR images in the Medtronic StealthMerge software environment. After the iEEG monitoring , multiple habitual seizures were recorded , eloquent areas were also identified by electrical stimulation of the cortex. The epileptic zone and the eloquent areas were marked on the subdural electrodes respectively. Then, 3D tessellations of the epileptic zone and the eloquent areas were rendered. Results Six patients (4 male, 2 female) were enrolled in this study. The mean time of iEEG monitoring was 13.7 days. After the coregistration of postoperative CT with preoperative 3D MRI , the 3D stereoscopic reconstruction provided an accurate representation of the implanted electrodes with highly detailed visualization of the underlying anatomy. The visual comparison between 3D reconstructions and intraoperative photographs indicated a good correspondence. The patients were followed for 3 to 6 months after the secondary operation , and had continuing improvement in seizure control. Conclusions The results indicate that the 3D reconstruction of subdural electrodes can reveal the precise localization of subdural electrodes , and can be useful for the presurgical evaluation of epileptic patients.