作者：王玉根，张光明，孟大伟，陈建伟，陈国强

单位：

1.261000山东省潍坊市，潍坊医学院 2.100012北京市，北京航空总医院神经外科 通信作者：陈国强，E-mail：13311396583@163.com

Units：

1.Weifang Medical University, Weifang 261000, China 2.Department of Neurosurgery, Beijing Aviation General Hospital, Beijing 100012, China Corresponding author: CHEN Guoqiang, E-mail: 13311396583@163.com

关键词：

癫痫; 耐药性癫痫; 药物难治性癫痫; 脑电图; 立体定向脑电图; 磁共振成像;

Keywords：

Epilepsy; Drug resistant epilepsy; Drug-resistant epilepsy; Electroencephalography;Stereoelectroencephalography; Magnetic resonance imaging

CLC：

DOI：

10.12114/j.issn.1008-5971.2022.00.178

Funds：

摘要：

目的 探讨立体定向脑电图(SEEG)在磁共振成像(MRI)阴性中央区药物难治性癫痫中的应用价值。方法 回顾性选取2016年1月至2021年12月航空总医院神经外科收治的采用SEEG定位致痫灶并完成手术治疗的MRI阴性中央区药物难治性癫痫患者10例。所有患者植入SEEG电极后,综合定位评估后明确致痫灶及功能区,然后行手术切除致痫灶,随访观察术后癫痫控制效果和神经功能缺损情况。结果 10例患者植入电极数量为9～18根,共109根,平均(10.9±2.92)根;触点总数为1 112个,其中涉及中央区电极97根,触点数为978个。SEEG时间为3～24 d,平均(10.9±6.1)d。电极植入及长程视频脑电监测过程中无颅内出血、电极脱落、颅内感染、脑脊液漏等并发症发生。10例患者均根据Ⅱ期评估结果进行了局部脑皮质切除术,术后随访6～19个月,平均(11.6±3.9)个月。癫痫控制效果:EngelⅠ级6例,EngelⅡ级2例,EngelⅢ级2例,治愈率为8/10。10例患者中术后出现肢体及面部麻木7例,均于3个月后消失;术后出现对侧肢体瘫痪2例,其中1例患者术后3个月肌力恢复正常,另1例患者术后3个月下肢肌力恢复至4级、上肢肌力正常。结论 SEEG可精确定位MRI阴性中央区药物难治性癫痫的致痫灶,术后不遗留明显的神经功能障碍,适合用于MRI阴性中央区药物难治性癫痫患者的术前评估。

Abstract：

【Abstract】 Objective To explore the application value of stereoelectroencephalography (SEEG) in MRI-negativedrug-resistant epilepsies in central region. Methods Retrospectively selected 10 patients with MRI-negative drug-resistantepilepsies in central region in Department of Neurosurgery in Beijing Aviation General Hospital from January 2016 to December2021, who had been located the epileptogenic focus and treated surgically by SEEG. All patients were implanted the SEEGelectrodes, and comprehensively assessed the connection of the epilepsy zone and functional areas, then epileptogenic focus weresurgically removed. Follow-up was performed to assess efficacy of the surgery and neurological dificit. Results The number ofimplanted electrodes in 10 patients was 9-18, a total of 109 electrodes, averagely (10.9±2.9) . These electrodes totally contain1 112 roots, and 97 electrodes including 978 roots in central region. The duration of monitoring SEEG was 3-24 days, averagely(10.9±6.1) days. In the process of electrodes implanted and the period of SEEG monitoring, there were not any complicationsincluding intracranial hemorrhage, electrode loss, intracranial infection, cerebrospinal fluid leakage and so on. Ten patients wereremoved focal cerebral cortex according to phase Ⅱ preoperative assessment, and followed up for 6-19 months after surgery,averagely (11.6±3.9) months. Epilepsy control effect: 6 cases of Engel grade Ⅰ, 2 cases of Engel grade Ⅱ and 2 cases of Engelgrade Ⅲ, with a cure rate of 8/10. Of the 10 patients, 7 patients had limb and facial numbness after operation, which disappearedafter 3 months; 2 patients had contralateral limb paralysis after operation, of which one patient recovered to normal muscle strength3 months after operation, and the other patient recovered to grade 4 muscle strength 3 months after operation, and the upper limbmuscle strength was normal. Conclusion SEEG can accurately locate the epileptogenic focus of MRI-negative drug-resistantepilepsies in central region, without obvious neurological dysfunction after operation, and is suitable for preoperative evaluation ofMRI-negative drug-resistant epilepsies in central region.

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