颞叶癫痫致痫灶定位方法准确性临床研究

目的探讨颞叶癫痫致痫灶综合定位方法的准确性,总结出简便准确的综合定位程序。方法回顾性分析60例手术治疗的难治性颞叶癫痫患者资料,分析归纳所采用的不同致痫灶综合定位方法,并以此将病例分为5组：A组为磁共振（MRI）阳性＋视频脑电图（VEEG）＋皮层及深部电极（ECoG及DEEG）组,B组为MRI阳性＋VEEG＋单光子发射计算机断层成像（SPECT）＋ECoG及DEEG组,C组为MRI阳性＋VEEG＋正电子发射计算机断层显像-计算机体层扫描（PET-CT）＋ECoG及DEEG组,D组为MRI阴性＋VEEG＋SPECT＋ECoG及DEEG组,E组为MRI阴性＋VEEG＋PET-CT＋ECoG及DEEG组。所有病例均获随访,按Engel分级进行术后疗效评估,以Ⅰ～Ⅲ级作为效果良好的评价标准,并作为致痫灶定位准确的标准,通过统计学分析,计算出各种方法的定位准确率,对不同综合定位程序的定位能力做出评价。结果致痫灶准确定位病例A组16例（16/18）,B组10例（10/11）,C组16例（16/17）,D组3例（3/4）,E组8例（8/10）;A、B、C三组间定位能力无显著差异,D、E组明显低于A、B、C三组,D组定位能力最差。结论 MRI结果阳性且与VEEG一致者可定位致痫灶;MRI阴性而VEEG与PET-CT结果一致者可定位致痫灶;术中皮层及深部电极监测是致痫灶再定位及指导手术的标准。

A clinical study of the accuracy of location methods for temporal lobe seizure foci

Objective To explore the accuracy of location methods for temporal lobe seizure foci and summarize the simple and accurate location procedure.Methods The clinical data of 60 cases of intractable temporal lobe epilepsy were analyzed retrospectively and different location methods for seizure foci were summarized. All the cases were divided into 5 groups according to the location methods： group A,positive magnetic resonance imaging （MRI） ＋ video electroencephalography （VEEG） ＋ depth electroencephalography （DEEG） and electrocorticography （ECoG）; group B,positive MRI ＋ VEEG ＋single photon emission computed tomography （SPECT） ＋ DEEG and ECoG; group C,positive MRI ＋ VEEG ＋ positron emission computed tomography-computed tomography （PET-CT）＋DEEG and ECoG; group D,negative MRI＋VEEG＋SPECT＋ DEEG and ECoG; group E,negative MRI ＋ VEEG ＋ PET-CT＋ DEEG and ECoG. All cases were followed-up and the postoperative efficacy was evaluated according to Engel classification. Engel Ⅰ~Ⅲ was regarded as good postoperative results and the standards for the accurate location of seizure foci. All the results were analyzed by statistics to calculate the location accuracy of various methods and assess the location capability of different combined procedures. Results The case number of accurate location of seizure foci was 16 （16/18） in group A,10 （10/11） in group B,16 （16/17） in group C,3 （3/4）in group D and 8 （8/10） in group E. There was no significant difference among group A,B and C in location accuracy,while group D and E were significantly lower than group A,B and C in location accuracy,with group D the worst one. Conclusion Consistency between positive MRI results and VEEG could accurately locate the seizure foci; for cases with negative MRI results,consistency between VEEG and PET-CT could accurately locate the seizure foci. DEEG and ECoG are necessary for the location of seizure foci during the operation.