CAJ | 학술논문

目的探讨影像学表现阴性的额叶局灶性皮质发育不良(FCD)的诊断和定位方法,为其手术治疗提供依据.方法选择自2008年3月至2010年6月河北省人民医院功能神经外科收治的患者,联合应用视频脑电图(VEEG)、弥散张量成像(DTI)检查,诊断定位并经手术证实影像学表现阴性的额叶FCD,对其临床资料进行回顾性分析.结果发作间期记录到病程放电或阵发异常棘波21例,其中额叶占优势但多个异常灶16例,非额区局灶异常5例,正常者7例.感兴趣区(ROI)的表观弥散系数值(ADC)较对侧额叶显著升高,而部分各向异性(FA)值明显低于对侧额叶,差异有统计学意义(P＜0.05).28例患者病理结果显示ⅠA型6例,ⅠB型9例,ⅠC型8例,ⅡA型5例.全部患者术后随访12～26个月,平均17.3个月,效果达到Engel's Ⅰ A级7例,ⅠB级10例,Ⅱ级8例,Ⅲ级3例.结论联合应用VEEG和DTI技术可以准确诊断、定位影像学检查阴性的额叶FCD,从而为精确切除致痫灶,提高额叶癫痫控制率提供保障.
목적 탐토영상학표현음성적액협국조성피질발육불량(FCD)적진단화정위방법,위기수술치료제공의거.방법 선택자2008년3월지2010년6월하북성인민의원공능신경외과수치적환자,연합응용시빈뇌전도(VEEG)、미산장량성상(DTI)검사,진단정위병경수술증실영상학표현음성적액협FCD,대기림상자료진행회고성분석.결과 발작간기기록도병정방전혹진발이상극파21례,기중액협점우세단다개이상조16례,비액구국조이상5례,정상자7례.감흥취구(ROI)적표관미산계수치(ADC)교대측액협현저승고,이부분각향이성(FA)치명현저우대측액협,차이유통계학의의(P＜0.05).28례환자병리결과현시ⅠA형6례,ⅠB형9례,ⅠC형8례,ⅡA형5례.전부환자술후수방12～26개월,평균17.3개월,효과체도Engel's Ⅰ A급7례,ⅠB급10례,Ⅱ급8례,Ⅲ급3례.결론 연합응용VEEG화DTI기술가이준학진단、정위영상학검사음성적액협FCD,종이위정학절제치간조,제고액협전간공제솔제공보장.
Objective To investigate the methods of diagnosis and localization for imaging negative frontal focal cortical dysplasia (FCD),and provide the basis fo operation treatment.Methods Twenty-eighty patients with imaging negative frontal FCD,admitted to our hospital from March 2008 to June 2010 and proved by pathological diagnosis,were chosen in our study; retrospective analysis on their clinical data,video electroencephalogram (VEEG) and diffusion tensor imaging (DTI) data was performed.Results The spike wave of paroxysmin and discharge at interictal phase was noted in 21 patients,including 16 with frontal advantage and multiple lesions.The apparent diffusion coefficient in the regions of interest was significantly increased,while the fractional anisotropy value was significantly decreased as compared with the contralateral ones (P＜0.05).Pathological reports showed 6 FCD type ⅠA,9 type ⅠB,8 type ⅠC and 5 FCD type ⅡA in all 28 patients treated by operation.All patients were followed up for 12 to 26 months,with an average of 17.3 months.Engel' s I grade A was noted in 7,grade B in 10,grade Ⅱ in 8,and grade Ⅲ in 3.Conclusion Combined application of VEEG and DTI can accurately diagnose and locate the negative imaging frontal FCD,guide the precise excision of epileptogenic focus and improve the control rate of frontal lobe epilepsy.