脑磁图对颞叶以外癫痫颅内电极置入的指导价值

目的研究在颞叶以外癫痫的诊疗中,脑磁图对颅内电极置入方案的指导价值。方法自2011年3月至2013年9月,对将行颅内电极置入的顽固性癫痫患者评估,先在电-临床症状学、影像学、脑电图等结果的基础上设计出初步的颅内电极埋置方案,然后添加MEG定位信息,并根据MEG调整电极埋置方案,得出最终颅内电极置入计划。继而行颅内脑电图监测并行手术治疗。最后分析颞叶以外癫痫中,脑磁图对颅内电极置入方案的指导价值。结果成功定位癫痫发作起始区并完成手术治疗、且经颅内电极证实为颞叶以外癫痫（NTLE）者有22例。9例（40.1%）患者MEG对iEEG电极置入方案产生额外于其它常规评估手段的指导作用（因MEG而增加电极覆盖）,其中7例（31.8%）经iEEG证实这些增加的定位信息与发作起始区一致。术后平均随访33.3个月：EngelⅠ级14例（63.6%）,EngelⅡ级3例（13.6%）,EngelⅢ级3例（13.6%）,EngelⅣ级2例（9.1%）。结论区别于视频脑电图、MRI等其它的无创检查,MEG能够对有创的iEEG电极埋置方案起到额外指导作用,能使电极埋置更合理精确、有针对性,并可能提高癫痫手术的疗效。

The value of meg to guide electrode implantation in non-temporal lobe epilepsy

Objective To explore the application of MEG combined with intracranial EEG in non-temporal epilepsy surgery.Methods From 2010 to 2013,we applied MEG to the presurgical evaluation of the intractable epilepsy patients who were to undergo intracranial electrodes implantation.We designed primary implantation plan based on the electrical-clinical semiology,neuroimaging and EEG information of the patients.Secondly the MEG results would be taken into account,and depth electrodes would be added to the area that MEG suggested in the plan,and from this we obtained the final implantation plan.We performed epilepsy surgery after iEEG monitoring.Results At last 23 cases were indentified of NTLE depend on the localization of iEEG ictal onset zone and underwent surgery.In 9cases（40.1%）,MEG provided additional information for guiding the electrodes implantation.Among them,7cases（31.8%）show concordance between MEG and iEEG result.After 33.3months＇ follow-up by mean,the results of seizure control was as followed：Engel classⅠ14cases（63.6%）,classⅡ3cases（13.6%）,classⅢ3cases（13.6%）,classⅣ2cases（9.1%）.Conclusion Distinguished from other noninvasive examinations like Vedio-EEG,MRI and so on,MEG can provide additional guidance to the electrodes implantation plan.Application of MEG combined with intracranial EEG would make the implantation plan more precise,more pointed,and possiblely improve the efficiency of the epilepsy surgery.