皮质电极监测在致痫性蛛网膜囊肿手术中的应用

目的探讨术中皮质电极监测在致痫性蛛网膜囊肿手术治疗中的应用价值。方法蛛网膜囊肿病人19例,术前均有癫痫发作史,CT或MRI检查确诊。术前常规脑电图检查正常3例,轻度异常8例,中度异常6例,重度异常2例。常规开颅行蛛网膜囊壁全部或部分切除,同时行皮质电极监测,根据癫痫波位置行致痫灶切除或软膜下横切术。结果 19例病人术中皮质电极均监测到癫痫波,其中12例行致痫灶切除术,4例行多处软膜下横切术,3例行多处软膜下横切并颞极、海马切除术。术后常规脑电图检查均未见癫痫波。随访6个月～4年,18例癫痫消失;1例发作明显减少,口服药物可控制。结论在致痫性蛛网膜囊肿病人手术中,使用皮质电极监测致痫灶,定位准确,灵敏度高。     

皮层脑电图监测切除伴发癫痫的颅内病变

目的:探讨皮层脑电图(CEEG)监测下切除伴癫痫症状的颅内病变手术效果。方法:23例患者,其中胶质瘤9例,动静脉畸形2例,脑膜瘤6例,蛛网膜囊肿6例。术中行CEEG监测,先切除病变再行CEEG监测,如仍有棘慢波则提示仍存在痫灶,时非功能区则予以切除,对功能区则用低功率电灼该处皮层,直至棘波和慢波消失。结果:23例患者切除病变前均可通过CEEG捕捉到痫波,病变及痫灶完全切除或热灼后,术后常规脑电图检查全部病例均未发现癫痫波。出院后随访12～23个月,22例痊愈,1例尚有部分性发作,但发作频率明显减少,间隔时间延长,口服抗癫痫药可控制。结论:术中CEEG监测可明确致痫灶位置,对提高手术疗效有一定价值。     

癫痫患者致痫灶切除前后头皮脑电图的比较

目的:回顾性分析比较35例癫痫患者致痫灶切除手术前后头皮脑电图癫痫样波的变化及术后3个月头皮脑电图癫痫样渡和术后3个月内发作与否之间的关系.方法:对我院2003年35例癫痫患者致痫灶切除手术前后头皮脑电图癫痫样波的数量及术后发作情况和术后头皮脑电图癫痫样坡数量进行回顾性分析.结果:35例患者中26例术后头皮脑电图癫痫样放电较术前明显减少或消失(74.3%),9例患者术后头皮脑电图癫痫样波未见明显减少(25.7%).术后3个月内无发作30例(85.7%),其中24例(80%)术后脑电图癫痫样波明显减少或消失,6例(20%)术后头皮脑电图癫痫样渡较术前无明显变化.术后3个月内有发作5例(14.3%),其中2例(40%)术后头皮脑电图癫痫样波较术前减少,3例(60%)术后脑电图癫痫样波未见明显变化.结论:癫痫患者致痫灶切除手术可使头皮脑电图癫痫样放电明显减少,术后无发作的患者中头皮脑电图癫痫样放电减少或消失的比例高于术后有发作的患者.     

血管内栓塞对颅内动静脉畸形的治疗

脑动静脉畸形(AVM)是颅内出血及癫痫的常见原因之一,其致残率及致死率均较高,我院1997- 0 2～2 0 0 3- 0 3共收治颅内动静脉畸形(AVM) 9例,经血管内NBCA胶栓塞治疗颅内AVM 7例(其中真丝线段 NBCA胶栓塞1例) ,钨丝弹簧圈栓塞治疗2例(其中真丝线段 钨丝弹簧栓栓塞1例) ,疗效较好,总结如下。1　对象和方法1.1　对象　本组男7例,女2例,年龄11～5 4岁,平均2 6岁。首发症状为蛛网膜下腔出血者6例,有头痛史5例,癫痫发作4例,合并脑内血肿2例,伴有肢体运动障碍者4例。全部患者均行CT、MRI或MRA及DSA检查。AVM病变均位于大脑半球(左侧6例…     

视频脑电图监测下幕上与癫痫有关的海绵状血管瘤显微外科手术患者的护理

颅内海绵状血管瘤属于脑血管畸形的一种类型,占所有脑血管畸形的5%～16%[1],癫痫是脑血管畸形的主要临床表现之一,其发生率可达33.1%～37.0%[2],幕上与癫痫有关的海绵状血管瘤在视频皮层脑电图(ECoG)监测下做病灶和痫灶切除,是控制术后癫痫发作的有效手段.     

皮层脑电图监测下切除有癫痫症状的脑肿瘤

[目的]探讨皮层脑电图监测下切除或热灼伴有癫痫症状的脑肿瘤的手术效果.[方法]16例伴有癫痫症状的脑肿瘤患者,术中通过皮层脑电图确定癫痫灶,切除肿瘤后,切除或热灼可疑癫痫灶,术后随访患者癫痫发作情况.[结果]16例患者切除肿瘤前均可通过皮层脑电图探及痫波,肿瘤及病灶完全切除后,痫波消失者14例,术后14例未再有癫痫发作,2例功能区患者虽多次皮层热灼,仍可见偶发棘波,有部分性发作,用抗癫痫药可控制.[结论]术中皮层脑电图监测切除或热灼癫痫灶是一种有效控制肿瘤切除术后癫痫发作的方法.     

视频脑电图结合MRI检查对药物难治性癫痫诊断的价值

目的探讨用视频脑电图和MRI诊断药物难治性癫痫的临床价值。方法收集2006年12月一2010年5月间经手术和病理证实的药物难治性癫痫患者38例。其中,海马硬化25例,颞叶萎缩伴脑发育不良2例,脑灰质移位及巨脑回4例,血管畸形3例,胶质瘤2例,脑内囊肿1例,外伤性癫痫1例。用视频脑电图监测癫痫发作期及发作间期痫样放电的来源部位及脑电活动特点,用MRI扫描显示痫灶区的表现特征,并与手术、病理改变对照,进行回顾性分析。结果视频脑电图对癫痫发作期的致痫灶来源定位准确率为100％（38／38）,发作间期定位准确率为53％（20／38）。MRI对发作间期的致痫灶及相关病变定位诊断准确率为89％（34／38）,病变定性准确率为79％（30／38）。结论视频脑电图和MRI检查有机结合,对药物难治性癫痫,能更有效检出致痫灶的部位及性质,为药物难治性癫痫患者的手术治疗,提供重要信息。     

皮层脑电图监测下切除伴有癫痫的幕上脑膜瘤

目的 探讨皮层脑电图监测下幕上脑膜瘤伴有癫痫的手术疗效.方法 我们于2004年9月至2008年1月对32例幕上脑膜瘤伴有癫痫的患者行手术治疗.所有患者术前行常规脑电图和头颅磁共振检查,手术均在皮层脑电图监测下进行,术中根据皮层脑电图监测结果,8例加行残留致痫灶切除,12例加行皮层热灼术.术后规律服用抗癫痫药物,至少1年.结果 Simpson Ⅰ级切除26例,Simpson Ⅱ级切除6例.术后随访1年以上,疗效满意,30例无癫痫发作,2例偶有癫痫发作.结论 皮层脑电图监测下切除肿瘤及周围致痫灶,必要时行皮层热灼术可提高本病的手术疗效.     

癫痫源灶切除术中的皮层电图监测45例

本文总结了45例颅内癫痫源灶切除术中的皮层电图监测。大脑病变所致的癫痫放电,术前虽经脑电图、CT进行了颅外癫痫灶定位但开颅后仍需用皮层电图作癫痫源灶的精确定位,以避免切除时造成痫灶残留或损伤重要脑功能区。本组术后随访2～10年,多数病例发作控制或基本控制,复查脑电图,原有病理波消失或明显减少,其背景活动接近正常。     

脑皮质电图在外伤性癫痫手术中的价值

目的：讨脑皮质电图(EcoG)对外伤性癫痫手术中的价值。方法：对13例外伤性癫痫术前作头皮脑电图（EEG）,术中ECoG监测精确,定位下行痫灶切除。结果：13例ECoG痫灶定位均准确,疗效满意。结论：EEoG对外伤性癫痫灶精确定位,确定手术方式和指导手术切除范围有重要价值。     

脑梗死后早发性癫痫发作的发生率及其影响因素分析

[目的]了解脑梗死后早发性癫痫发作的发生率并分析其影响因素.[方法]对426例脑梗死患者脑梗死后早发性癫痫发作的发生情况进行回顾性分析;应用统计学方法分析脑梗死后症状性癫痫与各影响因素的关系.[结果]426例患者中有早发性癫痫发作的患者56例,占13.15% ,发作类型以全身强直-阵挛性发作多见.单因素分析显示,皮质脑梗死、复发脑梗死、电解质紊乱患者易发生脑梗死后早发性癫痫发作;Logistic回归分析显示,梗死部位、梗死次数和电解质情况与脑梗死后早发性癫痫发作有关,其中皮质脑梗死为脑梗死后早发性癫痫发作的独立危险因素.[结论]脑梗死后早发性癫痫发作的发生率较高,皮质脑梗死、复发脑梗死以及电解质紊乱是脑梗死后早发性癫痫发作的影响因素,皮质脑梗死为独立的危险因素.     

Seizures after Onyx embolization for the treatment of cerebral arteriovenous malformation

Onyx embolization of cerebral arteriovenous malformations (AVM) has become increasingly common. We explored the risk of seizures after Onyx use.A retrospective review was conducted of 20 patients with supratentorial brain arteriovenous malformation (AVM) who received Onyx embolization between 2006 and 2009. Baseline demographics, clinical history, seizure history, AVM characteristics and treatment were compared between those who developed post-onyx seizure and those who did not. MRIs were reviewed for edema following Onyx treatment.Of 20 patients who underwent Onyx embolization, the initial AVM presentation was hemorrhage in 40% (N=8). The median number of embolizations was two (range 1-4) and the median final obliteration amount was 90% (range 50-100%). A history of seizure was present in 50% (N=10) of patients pre-embolization and 12 (60%) patients received seizure medications (treatment or prophylaxis) prior to embolization. Seizur post-Onyx embolization occurred in 45% (N=9). The median time to seizur post-Onyx was seven days (range 0.3-210). Four patients (20%) with seizures post-Onyx had no seizure history. Two of these patients (10%) had no other identifiable cause for seizure other than recent Onyx embolization. Seizures in these two patients occurred within 24 hours of Onyx administration. Among patients with post-Onyx seizures, there was a trend toward larger AVM size (P=0.091) and lower percent obliteration (P=0.062). Peri-AVM edema was present in 75% of MRIs performed within one month of Onyx treatment and may represent a possible etiology for seizures.New onset seizures post-Onyx embolization are not uncommon. Further study of seizure prevention is warranted.     

PET—CT脑3D显像在癫痫定位的临床应用价值

目的研究18F-FDG PET-CT脑3D显像对致痫灶定位的应用价值。方法癫痫患者13例,皆行18F-FDG脑三维PET显像,通过目测和半定量方法分析图像。所有患者均行EEG检查,其中2例行皮层脑电图（EeoG）或深部脑电图（DEEG）;12例行脑MRI或Cr检查。结果（1）13例中,PET阳性表现为低代谢灶者检出率为92．3％（12／13例）,明显高于EEG和脑MRI／CT（分别为92．3％、69．2％、33．3％,X^2分别为14．3、35．0,P均〈0．01）。单病灶检出率PET明显高于EEG（分别为61．5％和38．4％,X^2=23．1,P〈0．01）。与皮层脑电图（EcoG）或深部脑电图（DEEG）相比较,PET对致痫灶的检出灵敏度为95％,定位准确性为89％。结论18F-FDGP田在致痫灶的检出及定位方面有较高的灵敏度和准确性;在引导癫痫外科手术及放射定向治疗方面有较好的实用价值。     

The frequency of seizures in patients with primary brain tumors or cerebral metastases. An evaluation from the Ludwig Boltzmann Institute of Neuro-Oncology and the Department of Neurology,Kaiser Franz Josef Hospital,Vienna

Epileptic seizures are common in patients with cerebral metastases as well as in patients with primary brain tumors. In cancer patients without primary brain tumors or brain metastasis, epileptic seizures may occur due to metabolic or toxic causes, or due to infections. We performed a retrospective analysis from our neurooncological database concerning the occurrence of seizures in patients with primary brain tumors, patients with cerebral metastases and in cancer patients without brain tumors. Patients with low grade gliomas, such as astrocytoma WHO I + II (69%), oligodendroglioma WHO II (50%), and mixed glioma WHO II-III (56%) were more likely to have seizures than patients with anaplastic glioma WHO III (44%), glioblastoma WHO IV (48%) or meningeoma (45%). In patients with brain metastasis, melanoma (67%), cancer of the lung (29%), and gastrointestinal tumors (21%) were the primaries with the highest frequency of seizures. In cancer patients without brain metastases or primary brain tumors, seizures occurred in 4%. In conclusion, the occurrence of epileptic seizures in patients suffering from primary brain tumors, as well as in patients with cerebral metastases, varied within the tumor entity. Therefore, especially in brain tumors where a higher probability of epileptic seizures is expected, they should be taken into account in the care of cancer patients.     

幕上肿瘤伴发癫(癎)的精确定位和手术疗效分析

目的 探讨幕上肿瘤伴发癫(癎)的精确定位价值和手术治疗效果,研究肿瘤与致(癎)灶的关系.方法 对121例(胶质瘤Ⅰ级15例、Ⅱ级35例、Ⅲ～Ⅳ级12例,脑膜瘤32例,脑转移瘤10例,海绵状血管瘤15例,室管膜瘤2例)临床上以癫(癎)为首发症状的幕上肿瘤患者术前、术后癫(癎)发作情况等,临床资料进行回顾性分析.结果 采用术前影像和脑电结合定位、术中皮层脑电再次定位的方法,对肿瘤和癫(癎)灶同时切除,无手术死亡.癫(癎)发生率最高在额叶,最低在枕叶.癫(癎)灶与肿瘤的关系:位于同一部位者50例;致(癎)灶位于肿瘤一侧或近旁者28例;致(癎)灶位于肿瘤远隔部位(＞2 cm)25例;检测不到致痫灶者18例.失访18例,103例随访1～9年,31例术后早期仍有小发作,83例不再服抗癫(癎)药物癫(癎)症状完全消除.结论 在幕上肿瘤伴发癫(癎)患者中,致(癎)灶与肿瘤灶存在一定的差异性.在开颅切除肿瘤的同时必须明确致(癎)灶的位置和范围,一并切除才能达到良好的手术效果.     

Imaging the neocortex in epilepsy with double inversion recovery imaging

The neocortices of 10 patients with partial seizures and acquired lesions, 14 patients with malformations of cortical development (MCD) and 33 patients with partial seizures and normal conventional MRI were quantitatively evaluated using whole brain double inversion recovery imaging (DIR) and Statistical Parametric Mapping (SPM). Compared to a group of 30 control subjects, DIR and objective voxel-by-voxel statistical comparison identified regions of significantly abnormal DIR signal intensity (DSI) in 9 out of 10 patients with acquired nonprogressive cerebral lesions and partial seizures. In all 9 patients, the areas of abnormal DSI concurred with abnormalities identified on visual inspection of conventional MRI. In all 14 patients with MCD, SPM detected regions of significantly abnormal DSI; all of which corresponded to abnormalities identified on visual inspection of conventional MRI. In addition, in both groups, there were areas that were normal on conventional imaging, which demonstrated abnormal DSI. Voxel-by-voxel statistical analysis identified significantly abnormal DSI in 15 of the 33 patients with cryptogenic focal epilepsy. In 10 of these, the areas of abnormal DSI concurred with epileptic EEG abnormality and clinical seizure semiology. Group analysis of MRI-negative patients with electroclinical seizure onset localising to the left temporal and left and right frontal regions revealed significantly abnormal DSI within the white matter of each respective lobe. DIR analysed using SPM was sensitive in patients with MCDs and acquired cerebral damage. Significant abnormalities in DSI in individual and grouped MRI-negative patients suggest that occult epileptogenic cerebral lesions are associated with subtle structural abnormalities. DIR is, therefore, a useful quantitative MRI technique for characterising epileptic foci and may contribute to presurgical evaluation.     

脑卒中后继发癫痫的临床观察

目的探讨脑卒中后继发癫痫与脑卒中的临床关系。方法对456例脑梗死患者的临床资料进行回顾性分析。结果脑卒中后继发癫痫49例,占10．75％,癫痫发作类型以全身强直阵挛发作多见,脑卒中以缺血性脑血管病癫痫发作较多,占63．27％,脑卒中以皮层受累多见。结论脑卒中后癫痫发作与卒中时间、类型、发生部位有关。     

Rare pathomorphologic findings in complicated migraine

137 patients suffering from classical or complicated migraine were investigated in the Neurology Department of the University of Vienna between 1971 and 1984. 13 of these patients were found to have pathological alterations and their case histories are presented. Clinically, 11 patients suffered from migraine accompagnée (in 2 cases accompanied by epileptic seizures), 1 patient had ophthalmoplegic migraine and 1 had a subarachnoid haemorrhage imitating migraine. The underlying pathological findings were: 1 tumour, 4 arteriovenous malformations, 4 aneurysms, 1 arterio-venous shunt, 1 pathological vascular network, 1 Moya-Moya syndrome and 1 intracerebral haemorrhage without detectable source of bleeding. 8 of the patients underwent successful surgery and most of them showed subsequent clinical improvement. The family history was positive in only 2 patients. The time interval between the occurrence of the first symptoms and the establishment of the final diagnosis was up to 25 years. The neurologist should undertake extensive investigation of the patient, including cerebral angiography, if the following criteria apply: hemicrania consistently on the same side; change in type of headache after a number of years; uniform complicating neurological symptoms; additional occurrence of epileptic seizures; manifestation of neurological symptoms after the prodromal phase; persistent neurological signs without remission; negative family history; persisting diffuse or locally accentuated EEG changes; pathological CAT results.     

脑内小脓肿的诊断和治疗方法选择

目的 探讨脑内小脓肿的诊断和最佳治疗方法。方法 收集近5年来诊治的52例脑内直径2．0cm以下小脓肿资料，对病史特征、CT及MRI表现和治疗结果进行回顾性分析。结果 41例无感染史，45例以癫痫发作起病并为主要症状，通常没有局部神经受损体征。单纯抗菌疗法治愈50例，手术治疗2例，其中1例术后留有轻度神经功能障碍。结论 脑内小脓肿的主要临床特征是癫痫发作，CT和MRI是诊断的关键手段，治疗上应首选非手术疗法，仅个别对抗菌疗法不敏感者才可考虑手术治疗。     

颅内肿瘤伴发癫的机制及外科治疗评价

临床上常见脑肿瘤伴发癫,但脑肿瘤与癫发生的关系仍很难确定。癫放电是脑皮层超同步放电的结果,无论是原发性还是继发性癫,都是大脑功能异常的表现,致灶脑生物电变化较其组织形态学变化更明显。因此,对颅内肿瘤伴发癫患者进行致灶定位时,既不同于单纯颅内占位病变者,也有别于其它顽固性癫患者。除了需要神经影像学检查发现病灶外,更要参考V-EEG的结果,结合临床表现和其它术前评估手段进行联合定位具有更大价值。在神经影像学和电生理指导下,行病变切除术+致灶切除术(或阻断性活动扩散的手术,如多处软膜下横切),可获得较好疗效,但并不能确保所有患者术后癫终止发作或得到明显改善。随着更多基础与临床研究的深入,人们对癫发病机制的理解将会更加深刻,对此类疾病的诊治也将会达到更高水平。