发作间期PET和SPECT检查对颞叶癫痫定位诊断价值

目的：探讨发作间期＾１８Ｆ－脱氧葡萄糖（ＦＤＧ）正电子发射断层扫描（ＰＥＴ）和＾９９ｍＴｃ－已撑半脱氨酸（ＥＣＤ）单光子发射断层扫描对顽固性颞叶癫痫（ＴＬＥ）的定位诊断价值。方法：５３例脑电图（ＥＥＧ）定位明确的顽固性ＴＬＥ患者分别行发作间期＾１８Ｆ－ＦＤＧＰＥＴ和＾９９ｍＴｃ－ＥＣＤＳＰＥＣＴ检查。其中２１例磁共振（ＭＲＩ）显示有结构性病变并与ＥＥＧ定位结果一致。结果：ＭＲＩ异常组均在ＰＥＴ和Ｓ     

发作间期PET和SPECT检查对颞叶癫痫定位诊断价值

目的：探讨发作间期１８Ｆ－脱氧葡萄糖（ＦＤＧ）正电子发射断层扫描（ＰＥＴ）和９９ｍＴｃ－己撑半脱氨酸（ＥＣＤ）单光子发射断层扫描对顽固性颞叶癫痫（ＴＬＥ）的定位诊断价值。方法：５３例脑电图（ＥＥＧ）定位明确的顽固性ＴＬＥ患者分别行发作间期１８Ｆ－ＦＤＧＰＥＴ和９９ｍＴｃ－ＥＣＤＳＰＥＣＴ检查。其中２１例磁共振（ＭＲＩ）显示有结构性病变并与ＥＥＧ定位结果一致。结果：ＭＲＩ异常组均在ＰＥＴ和ＳＰＥＣＴ相应部位出现低代谢和低灌注表现。ＭＲＩ正常组，ＰＥＴ定位准确性为８４．５％，显著高于ＳＰＥＣＴ的５６．３％（Ｐ＜０．０５）。结论：对于无结构性病变的颞叶癫痫，发作间期ＰＥＴ检查有较高的定位诊断价值，ＳＰＥＣＴ的临床意义相对较小     

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。     

偶极子在癫痫外科中对痫灶定位的价值

目的：探讨偶极子定位法（ＤＬＭ）对癫痫痫灶定位的价值。方法：对１３３例癫痫病人进行ＤＬＭ和ＣＴ－ＭＲＩ检查,部分病人行单光子发谢计算机断层扫描（ＳＰＥＣＴ）和正电子发射断层扫描（ＰＥＴ）检查;１２０例手术病人行皮层或深部电极验证并对其结果进行对比分析。结果：ＤＬＭ检查与术中电极结果一致,且精确度高（〈１ｃｍ）、特异性好。结论：ＤＬＭ是一种新型的无创伤癫痫痫灶定位方法,对局限性癫痫样波ＤＬＭ定位明显优于影像学方法。     

PET在颞叶癫痫诊断中的作用

目的评价PET检查在颞叶癫痫病人术前诊断中的意义.方法20例顽固性颞叶癫痫病人术前均行脑电监测、头MRI及PET检查.结果20例脑电监测中有19例监测到棘波、尖波或棘慢波,1例正常.脑电异常位于一侧11例,位于双侧8例.20例头MRI检查中有14例正常,6例一侧海马萎缩,1例双侧萎缩,1例右额顶囊肿伴垂体微腺瘤.20例PET检查均表现局部脑组织代谢减低.一侧异常16例,双侧异常4例.20例手术病人中有16例行颞叶前部及海马切除,4例行选择性海马切除.结论PET检查对于颞叶癜痫的定位诊断敏感可靠,比MRI更有价值.     

颞叶占位性病变伴癫痫患者的手术治疗研究

目的探讨颞叶占位性病变伴癫痫患者手术治疗的疗效,分析多种致痫灶定位技术的联合应用对手术疗效的影响。方法回顾性分析31例颞叶占位性病变伴癫痫患者术前脑电图及术后随访资料,其中囊性占位7例,海绵状血管瘤6例,胶质瘤16例,其他病变2例;应用MRI、视频脑电图、脑磁图行致痫灶定位,术中应用皮质脑电图再次精确致痫灶范围后行前颞叶联合海马切除术,术后随访评估疗效。结果长程VEEG监测中,20例患者均有惯常发作和发作间期痫样放电,14例(14/20)患者发作间期痫样放电位于单侧颞叶及海马区,其中合并同侧额区放电5例。6例(6/20)患者发作间期放电位于双侧颞叶,其中合并单侧额区放电2例。8例(8/20)起源于左侧颞叶及海马区,12例(12/20)起源于右侧。MEG检查20例患者发作间歇期皆有痫样放电,检出率为100%,17例(17/20)患者单侧颞叶放电,其中合并同侧额区放电8例;3例(3/20)患者双颞放电。术后随访12~24个月:16例患者Ⅰ级,3例Ⅱ级,1例Ⅲ级,手术有效率100%,效果良好率95%。结论颞叶占位性病变伴癫痫患者的手术治疗疗效好,多种致痫灶定位技术的联合应用可提高手术疗效并有效减少术后并发症。     

偶极子定位在癫痫外科治疗中的应用

偶极子三维颅内定位是一种无创性致痫灶定位方法,通过偶极子定位方法,结合三维MRI融合技术,偶极子能精确判断癫痫的起源性电活动,在解剖图像上显示功能异常的痫性病灶,对癫痫患者术前评估,手术入路的设计,切除范围等均有重要的作用,从而改善癫痫手术治疗效果。     

发作间期PET和 SPECT检查对颞叶癫痫定位的诊断价值

目的：探讨发作间期＾１８Ｆ－脱氧葡萄糖（ＦＤＧ）正电子发射断层扫描（ＰＥＴ）和＾９９ｍＴｃ－已撑半胱氨酸（ＥＣＤ）单光子发射断层扫描（ＳＰＥＣＴ）对难治性颞叶癫痫（ＴＬＥ）的定位诊断价值。方法；５３例脑电图（ＥＥＧ）定位明确的难治性ＴＬＥ患者分别行发作间期１８Ｆ０－ＦＤＧＰＥＴ和＾９９ｍＴｃ－ＥＣＤＳＰＥＣＴ检查。其中２１例磁共振（ＭＲＩ）显示有结构性病变并与ＥＥＧ定位结果一致。结果：ＭＲＩ异常组     

深部电极对颞叶癫痫定位的应用研究

目的 探讨深部电极脑电监测对颞叶癫痫灶定位的意义和安全性。方法 对12例颞叶癫痫病例，无创检查难以定位或定侧者，在立体定向指引下颅骨钻孔行双侧或单侧海马区深部电极植入，脑电监测对癫痫灶定位，根据手术中皮层电极及深部电极癫痫灶的定位、手术后疗效评价及术后脑电检查结果，研究深部电极脑电监测对致痫灶定位的准确性和安全性。结果 12例病人埋置深部电极23只，留置时间平均5天；监测时间平均10小时，明确定位5例(37．5％)，定侧的7例(62．5％)，并在术中和术后得到验证。所有病例无颅内出血和感染等并发症发生。结论 深部电极植入脑电监测对颞叶癫痫灶定位是行之有效的方法，可作为颞叶癫痫致痫灶定位的可靠指标；电极植入安全，定位准确性高。     

颅内电极监测对顽固性颞叶癫痫致痫灶的定位价值

目的:探讨发作期及发作间期颅内电极监测对癫痫灶的定位作用。方法:20例难治性颞叶癫痫,经临床、影像学及头皮脑电图不能确定致痫灶部位,应用立体定向技术,在患者双侧颞叶植入硬膜下条状电极,进行长时间视频脑电图监测,记录发作期和发作间期的脑电图变化,并与头皮脑电图、MRI进行比较,分析癫痫灶部位,进行手术治疗,术后跟踪随访,评估致痫灶定位的准确性。结果:20例癫痫病人颅内电极埋藏时间1～5天,每个患者至少监测到2次临床发作,每一病例均记录发作间期和发作期的异常放电活动。15例发作间期与发作期定侧一致,2例发作间期为双侧棘波病灶,3例发作间期定位与发作期不一致。按Engel术后效果分级:手术效果满意(癫痫发作消失)13例(65%),显著改善3例(15%),良好3例(15%),无效1例(5%)。所有病例均未出现因颅内电极埋藏而致的并发症。结论:对于致痫灶不能定位的难治性癫痫,应用颅内电极记录方法,尤其是发作期起始时脑电图变化,可以确定致痫灶位置,为癫痫手术治疗提供可靠的依据。     

发作间期癫痫灶的~(18)F-FDG PET/CT显像研究

目的 探讨~(18)F-FDG PET/CT对发作间期癫痫灶定性定位诊断价值.方法 病人空腹4-6 h以上,空腹血糖3.9～6.1 mmol/L,肘静脉注射显像剂~(18)F-FDG0.12 mCi/kg体质量,平静休息40 min后行脑部PET3D及CT断层显像,层厚3.75 mm,PET图像行衰减校正及迭代法重建多层面,多幅显示,连续两个层面以上肉眼可辨的放射性改变(低代谢、高代谢区)为癫痫灶.同时根据癫痫灶对放射性示踪剂的摄取进行半定量测定.对于多发癫痫灶采用痫灶部位及对侧同一部位SUVmax与小脑SUVmax相比.每个病人开颅后根据术前脑电、PET/CT结果行颅内电极(条状脑皮质电极、脑深部电极)监测癫痫灶的脑电情况,证实~(18)F-FDG PET/CT结果.结果 38例患者中37例检出癫痫灶,术中脑电证实癫痫灶部位较准确,1例颞叶癫痫未检出.单痫灶较多痫灶准确.结论 ~(18)F-FDG PET/CT是一种无创伤性、高度灵敏、较有效的癫痫灶定位方法.     

18F－FDGPET／CT显像对颞叶癫痫灶定位的价值

目的探讨以18氟-2-脱氧葡萄糖为显影剂的正电子发射断层扫描／计算机断层成像（18F-FDGPET／CT）对颞叶癫痫（TLE）灶的定位价值。方法本研究回顾分析被确诊为TLE的24例患者的临床资料,将术前18F-FDGPET／CT、MRI、视频脑电图（VEEG）与术中颅内电极脑电图和术后病理学检查结果进行对比研究。结果24例TLE患者中,18F-FDGPET／CT准确定位致痫灶21例,MRI准确定位10例,VEEG准确定位10例。18F-FDGPET／CT对TLE致痫灶的敏感性为87．5％（21／24）,其中对内侧颢叶癫痫（MTLE）致痫灶为88．9％（16／18）,对外侧颞叶癫痫（LTLE）致痫灶为83．3％（5／6）。MRI对TLE致痫灶的敏感性为41．7％（10／24）,其中对MTLE致痫灶为55．5％（10／18）,对LTLE致痫灶为0。VEEG对TLE致痫灶的敏感性为41．7％（10／24）,其中对MTLE致痫灶为50．5％（9／18）,对LTLE致痫灶为16．7（1／6）。18F-FDGPET／CT对TLE（包括MTLE和LTME）致痫灶的敏感性均显著高于MRI和VEEG（P〈0．05）,而MRI和VEEG对TLE致痫灶的敏感性无显著差异（P〉0．05）。结论18F-FDGPET／CT对于TLE致痫灶定位具有独特的优势。     

颞叶癫痫致痫灶的定位方法评价

探讨目的：用不同的方法对癫痫灶定位的评估。病程１２１．２个月,进行回顾。方法：利用症状学,神经心理学,头皮／蝶骨嵴脑电皮层脑电图,深部脑电图,ＣＴ,ＭＲＩ七种方法在４０例难治性颞叶癫痫中的应用,其中１３例患者定位的准确性通过手术后一年以上疗效的随访得到证实。结果：２１／４０例由症状学表现得到诊断,９／２７例由神经心理学测试定侧。头皮脑电图、皮层脑电图及深部脑电图的定位率分别为３０／４０、３０／３７和２９／３５。ＣＴ与ＭＲＩ的定位率分别为１２／２５和３２／４０。各种定位方法的准确性有显著差异,其中神经心理学的定位能力明显低于常规脑电图、ＭＲＩ、皮层脑电图和深部脑电图。结论：总结了各种定位方法的优劣势,指出准确的定位需要功能性定位与结构性定位方法的综合应用。最具价值的仍是侵袭性电极的检查,神经心理学的定位价值较小     

Gamma knife surgery for mesial temporal lobe epilepsy

PURPOSE: Gamma knife radiosurgery (GK) allows precise and complete destruction of chosen target structures containing healthy and/or pathologic cells, without significant concomitant or late radiation damage to adjacent tissues. All the well-documented radiosurgery of epilepsy cases are epilepsies associated with tumors or arteriovenous malformations (AVMs). Results prompted the idea to test radiosurgery as a new way of treating epilepsy without space-occupying lesions. METHODS: To evaluate this new method, we selected seven patients with drug-resistant "mesial temporal lobe epilepsy" (MTLE).The preoperative evaluation program was the one we usually perform for patients selected for microsurgery of TLE [video-EEG analysis of seizures, foramen ovale electrode recording, magnetic resonance imaging (MRI) positron emission tomography (PET) scan, neuropsychological testing]. In lieu of microsurgery, the amygdalohippocampectomy was performed by using GK radiosurgery. RESULTS: Morphologic (MRI) signs of destruction of the target took place at 9 months after GK surgery. Since the treatment day, the first patient has been seizure free. Seizure improvement came more gradually for the following patients, and complete cessation of seizures occurred around the tenth month (range, 8-15 months). MRI shows that the amygdaloentorhinohippocampal target was selectively injured. No significant side effect (except one case of homologous quadrantanopia) or morbidity and no mortality was observed. The current follow-up is 24-61 months, and all (but one) patients are seizure free. CONCLUSIONS: This initial experience proves clearly the short-to middle-term efficiency and safety of GK for MTLE surgery. These results need further confirmation of long-term efficiency, but the introduction of GK surgery into epilepsy surgery can reduce dramatically its invasiveness and morbidity.     

深部电极引导伽玛刀治疗颞叶内侧癫痫(附21例临床分析)

目的探索深部电极引导伽玛刀治疗颞叶内侧癫痫的方法,初步评价治疗效果。方法治疗21例颞叶内侧癫痫患者,其中男性13例,女性8例,年龄18~59岁,平均34.2岁,病史3~20年,平均13.5年。用无框架立体定向机器人技术进行深部电极植入,并进行深部电极长程视频脑电监测。本组双侧植入5例,单侧植入16例,植入监测时间1~7天,平均监测2.2天。明确致痫灶后,安装头架,行头颅CT扫描定位,然后拔除深部电极,行头颅核磁扫描。对头颅CT与核磁进行融合,明确致痫灶接触电极的位置,进行伽玛刀治疗。治疗剂量:周边剂量8~13 Gy,平均9.8 Gy;中心剂量16~26 Gy,平均18.2 Gy;50%等剂量曲线。结果随访6~36个月,平均15个月,Engel’s效果分级:Ⅰ级2例,Ⅱ级4例,Ⅲ级9例,Ⅳ级6例(Ⅰ~Ⅲ级为治愈及有效)。有效率为71.4%。手术并发症:颅内积气2例,1周后自行吸收。无其他手术并发症。结论颞叶内侧癫痫深部电极探测明确致痫灶后,应用CT及核磁融合技术,在深部电极引导下进行伽玛刀低剂量治疗,初步治疗结果满意。     

The topography and significance of extratemporal hypometabolism in refractory mesial temporal lobe epilepsy examined by FDG‐PET

Purpose: This study aims to map the temporal and extratemporal 18‐fluorodeoxyglucose positron emission tomography (FDG‐PET)–defined hypometabolism in mesial temporal lobe epilepsy (MTLE). We hypothesize that quantitative analysis will reveal extensive extratemporal glucose hypometabolism (EH), that the EH is related to seizure propagation beyond the temporal lobe, hypometabolism restricted to one temporal lobe predicts a good outcome following surgery, and EH predicts a poor outcome. Methods: Sixty‐four patients were studied who had undergone temporal lobectomy for intractable MTLE and had at least 2 years of postoperative follow‐up. Spatial preprocessing and statistical analysis on preoperative interictal FDG‐PET using statistical parametric mapping (SPM 2) identified significant regions of hypometabolism compared to normal controls. The predictors of outcome were determined by univariable and multiple logistic regression analyses. Results: EH was common and widespread, occurring most frequently in the ipsilateral insula and frontal lobe. The extent of EH was not significantly associated with age of onset or the duration of epilepsy. Presence of secondarily generalized tonic‐–clonic seizures (SGTCS) was associated with a larger extent of remote hypometabolism (RH, p < 0.005). Multiple logistic regression analysis identified the extent of RH and the age at surgery as independent predictors of seizure outcome. Discussion: Our results indicate that RH in MTLE is associated with a poorer surgical outcome, especially if seen in the contralateral hemisphere. The extent of RH relates to SGTCS but not to duration of epilepsy.     

Prognostic factors in anterior temporal lobe resections for mesial temporal lobe epilepsy: multivariate analysis

PURPOSE: Even though there have been several studies on the prognostic factors of temporal lobe epilepsy (TLE) after lobectomy, no studies have been performed for homogeneous mesial TLE. Furthermore, most studies on the predictors of outcome of epileptic surgery were based on univariate analyses and did not consider modern epileptic surgery investigation modalities such as brain magnetic resonance imaging (MRI) and positron emission tomography (PET). We attempted to identify the prognostic factors in anterior temporal lobectomy (ATL) for mesial TLE with multivariate analysis. METHODS: Ninety-three patients with mesial TLE (54 men and 39 women, mean age at surgery, 28.3 +/- 8.2 years) were included in the study. The primary outcome variable was the status of patients in the second postoperative year, classified as either seizure free (except aura), or not seizure free. Clinical, electroencephalographic, MRI, PET, Wada test, and pathological data were considered. RESULTS: Seventy-eight (84.0%) patients had remission of seizures. With univariate analysis, age at surgery (p < 0.001), epilepsy duration before surgery (p = 0.04), and ipsilateral hippocampal sclerosis on MRI (p = 0.02) were found to be significant. By using multivariate analysis, age at surgery (p = 0.001) and ipsilateral hippocampal sclerosis on MRI (p = 0.03) were found to be the most significant prognostic factors. CONCLUSIONS: Age at surgery and hippocampal sclerosis are independent prognostic factors for ATL in mesial TLE. These findings suggest that mesial TLE may be a progressive disorder, and surgical outcome is better when early ATL is performed.     

Volumetric evidence of bilateral damage in unilateral mesial temporal lobe epilepsy

PURPOSE: We sought to analyze the contralateral volumes of the temporal pole, posterior segment of the temporal lobe, amygdala, hippocampus, and parahippocampal gyrus in patients with temporal lobe epilepsy (TLE) due to histologically proven mesial temporal lobe sclerosis (MTLS), seizure free for >or=4 years of postsurgical follow-up. METHODS: Forty-six (23 male) TLE patients, operated on between 1996 and 2001, with histopathologic diagnosis of MTLS, and a postsurgical follow-up of >or=4 years, had their temporal lobe structures manually segmented, measured, and compared with those of 23 normal volunteers, paired as groups for sex, age, and handedness. RESULTS: The mean volumes of the contralateral temporal pole, hippocampus, and parahippocampal gyrus in TLE patients were significantly lower than those in controls. CONCLUSIONS: MRI volumetric data show that the damage in TLE due to MTS may be more widespread and bilateral, even in patients with unilateral TLE by clinical and neurophysiological criteria. Our results are relevant to the discussion of epileptogenic mechanisms in TLE.     

Short-term cognitive changes after surgery in patients with unilateral mesial temporal lobe epilepsy associated with hippocampal sclerosis

We investigated the short-term postoperative cognitive function of patients with unilateral mesial temporal lobe epilepsy associated with hippocampal sclerosis (MTLE/HS). Fourteen unilateral MTLE/HS patients who had undergone selective amygdalohippocampectomy (SAH) or anterior temporal lobectomy (ATL) were enrolled. Cognitive functions related to the frontal and temporal lobes were evaluated using a battery of neuropsychological tests administered before surgery and 3 months after surgery. The battery included the Verbal Fluency Test (VFT), Boston Naming Test (BNT), Stroop Color-Word Test (TST), Trail Making Test (TMT) and Wechsler Memory Scale (WMS). MTLE/HS patients demonstrated significantly improved postoperative performance on the TST regardless of the surgical method or side of resection. There was no significant difference in any of the other neuropsychological tests before and after surgery. After left-side resection, performance on the VFT and the TMT-B was worse than at baseline. After right-side resection, performance on the VFT and WMS short-term memory improved; however, these differences were not statistically significant. SAH patients exhibited improved TST performance but worse TMT-A performance; however, performance on all tests was not significantly different after surgery in ATL patients. In summary, MTLE/HS patients demonstrated improved frontal lobe-related cognitive function after surgery, but no such improvement in temporal lobe-related function was observed. Based on cognitive evaluation, right-sided MTLE/HS patients may be more appropriate surgical candidates than left-sided MTLE/HS patients. SAH may not be better than ATL in improving cognitive function. We hypothesise that postoperative cognitive changes depend on whether the excised cerebral regions are related to the neuropsychological functions examined by specific assessment instruments.     

Spontaneous periictal leaving behavior: A potential lateralizing sign in mesial temporal lobe epilepsy

Purpose:   Seizure-related spontaneous leaving behavior (LB) is an uncommonly reported phenomenon. The aim of this study was to determine its frequency, clinical significance, and especially its lateralizing value.
Methods:   We analyzed retrospectively the spontaneous periictal LB occurring in complex partial seizures (CPS) of 138 patients with medically refractory mesial temporal lobe epilepsy (MTLE) with excellent postoperative seizure outcome and pathologic finding of hippocampal sclerosis. The relation of LB occurring in different phases of CPS to the side of resection was investigated.
Results:   The overall frequency of periictal LB was 8.3% of 517 CPS and 25.2% of 123 patients. Among the 12 patients with ictal LB, 9 patients had epileptogenic focus ipsilateral to language dominant side, whereas the remaining 3 had seizure onset in the nondominant side. Conversely, 8 of 11 patients with postictal LB had foci in the nondominant side, and only three patients' seizures originated in the dominant side. Therefore, it was more likely for patients with left MTLE to show ictal LB and for those with right foci to display postictal LB (p = 0.03).
Conclusions:   LB may represent a potential lateralizing sign. When LB occurs ictally, it may indicate seizure onset in the dominant temporal lobe, and LB occurring postictally indicates nondominant side seizure onset in patients with MTLE.