脑磁图定位顽固性癫痫手术治疗51例临床分析

目的　探讨脑磁图在顽固性癫痫术前评估的价值。方法　术前对 5 1例顽固性癫痫患者行脑磁图、磁共振及视频脑电检查 ,结合术中皮层脑电图分别进行选择性海马杏仁核切除术、标准前颞叶切除术及致痫灶切除术等手术 ;并用脑磁图定位神经导航下手术切除致痫灶 2例 ,神经导航下海马杏仁核切除 2例。结果　术后发作完全停止的占 76 5 % ,发作减少 >75 %的占 11 8% ,发作减少>5 0 %的占 5 8% ,发作减少不足 5 0 %的占 5 8% ;脑磁图与视频脑电及皮层脑电图的定位符合率分别为 82 %和 96 % ;脑磁图对内侧颞叶癫痫的定位敏感性较差 ;脑磁图定位导航手术可在切除致痫灶的同时保护脑的重要结构。结论　脑磁图是一项灵敏的无创性癫痫灶定位方法 ,是癫痫外科术前评估中的一项技术突破

Clinical study of magnetoencephalographic(MEG) localization in intractable epilepsy surgery: a report of 51 cases

Objective To evaluate the value of magnetoencephalography(MEG) in preoperative localization of intractable epilepsy.Methods MEG, magnetic resonance imaging(MRI) and video electroencephalography(VEEG) were performed in 51 cases with intractable epilepsy before operation. The surgical methods included selective amygdalohippocampectomy, standard anterior temporal lobectomy and epileptogenic focus resection. Epileptogenic foci localized by MEG were resected under neuronavigation in 2 cases. Equi volume amygdalohippocampectomy was performed under neuronavigation in 2 cases.Results Among the 51 cases, 76.5% were seizure free, 11 8% greater than 75% reduction in seizures, 5 8% greater than 50% reduction in seizures and 5 8% less than 50% reduction in seizures after operation. Localization coincidence between MEG and VEEG plus ECoG were 82% and 96%, respectively. Localization sensitivity of MEG to medial temporal lobe epilepsy was not good enough. Resection of epileptogenic foci localized by MEG under neuronavigation could contribute to successful surgery with lower impairment of functional brain areas.Conclusions MEG is a noninvasive sensitive localization method for epileptogenic focus, it is a breakthough for epilepsy preoperative evaluation.