皮层电极描记配合立体定向切除癫痫灶

目的 评价皮层电极描记在立体定向切除癫痫灶手术中的应用和价值。方法 对25例以癫痫为首发症状的继发性癫痫患者采用MRI导向下，立体定向环钻开颅，切除病灶前行皮层电极描记，记录有无癫痫波和范围，切除病灶后再次描记，如仍有癫痫波，则在不影响神经功能的基础上将有癫痫波的皮层尽可能切除。结果 25例患者中有19例在切除病灶前记录到棘波、棘-慢波、尖波或尖-慢波，切除后有15例上述癫痫波完全消失，4例仍有散在的少许癫痫波；另有6例患者未记录到癫痫波，但表现为基本的节律异常，切除病灶后好转。25例患者中胶质瘤6例，脑囊虫病5例，蛛网膜囊肿3例，软化灶3例，皮层发育不全2例，血管畸形2例，转移癌2例，炎症1例，胶质细胞增生1例，病灶直径在0．8～4．7cm。手术后24例癫痫发作消失，1例仍偶有癫痫发作，比例能够被口服抗癫痫药物控制。手术后患者无神经功能损害加重。结论 皮层电极描记和立体定向方法相结合，既能明确癫痫灶的范围，又能以微侵袭的方法切除癫痫灶，尤其适用于直径小于4cm的癫痫灶的切除。

The application of intraoperative ECoG in stereotactic surgery to resect the epileptogenic focus

Objective To evaluate the value of intraoperative ECoG in stereotactic surgery to resect the epileptogenic focus.Methods 25 cases of epilepsy that had epileptogenic focus in brain were operated in stereotactic surgery by MRI guidance and used trephination.To apply the ECoG to record the spike wave before resecting the focus and record again after resecting the focus.It was necessary to continue to resect the area of spike wave if the ECoG still recorded the spike wave after resecting the focus,but needed not to injury the function.Results 19 cases were recorded spike wave before resection and disappered after resection.6 cases were not recorded spike wave,but recorded the abnormal rhythm,and after resection the rhythm was normal.There were 6 cases of glioma,5 cases of cerebral cysticercosis,3 cases of arachnoid cyst,3 cases of cortex malacia,2 cases of cortex dystrophia,2 cases of AVM,2 cases of metastatic carcinoma,1 case of inflammatory,1 case of gliosis.The diameter of focus was 0.8 to 4.7 centimeter.After operation the seizure were diaappeared in 24 cases,and 1 case has a little seizure,but could be controled by antiepileptic drug.After operation the damage of neurofunction did not aggravated.Conclusions The stereotactic surgery combined with ECoG was a valuable method.It could define the area of epileptogenic focus and was a micro-invasion method to resect the epileptogenic focus.It was special applied to resect the focus that the diameter lessed than 4 centimeter.