立体定向脑电图引导下多电极立体适形射频热凝毁损治疗药物难治性岛叶癫痫的疗效分析

目的分析立体定向脑电图（SEEG）引导下多电极射频毁损治疗药物难治性岛叶癫痫的安全性及有效性。 方法回顾性分析自2016年2月至2020年1月于首都医科大学三博脑科医院功能神经外科采用SEEG引导下多电极立体适形射频热凝毁损治疗的23例药物难治性岛叶癫痫患者的临床资料。所有患者均进行了严密的术前评估，包括症状学分析、头皮脑电、磁共振、脑磁图及正电子发射型计算机断层显像等。术前评估考虑患者致痫灶位于岛叶，根据评估设计电极验证致痫灶位于岛叶后，行多电极立体适形射频热凝毁损治疗。术后通过住院、门诊或电话进行随访，采用Engel分级进行预后评估，并观察手术相关并发症。 结果23例患者均在术后3、6、12、24个月进行随访，截至末次随访，12例患者术后癫痫发作消失（Engel Ⅰ级），5例患者术后偶见癫痫发作（Engel Ⅱ级），5例患者术后癫痫发作频率减少75%（Engel Ⅲ级），1例患者术后发作减少<75%（Engel Ⅳ级）。术后2例患者出现可恢复性深感觉障碍或运动性失语，均在1个月内回复，无永久性神经功能障碍。 结论SEEG引导下多电极立体适形射频毁损是治疗药物难治性岛叶癫痫患者安全、有效的治疗手段，可作为开放性切除手术的一种补充治疗方法。

Stereo-EEG-guided multiple electrode stereo-conformal radiofrequency thermocoagulation for the treatment of drug-resistant insular epilepsy

ObjectiveTo analysis the safety and efficiency of stereo-electroencephalography (SEEG)-guided multiple electrodes stereo-conformal radiofrequency thermocoagulation in the treatment of drug-resistant insular epilepsy. MethodsTwenty-three patients with drug-resistant insular epilepsy, underwent SEEG-guided multiple electrode stereo-conformal radiofrequency thermocoagulation at Functional Neurosurgery Department of Sanbo Brain Hospital Capital Medical University were retrospective analyzed from February 2016 to January 2020. Standard presurgical evaluation, including semiology, video electro-encephalographic recordings, magnetic resonance imaging, positron emission tomography, and magneto-encephalography, were performed on all the 23 patients, suggesting that the epileptogenic focus located in the insula lobe. According to the diagnosis, electrodes implantation was designed. As the epileptogenic focus inside the insular lobe was verified, the multi-electrode stereo-conformed radiofrequency thermocoagulation treatment was performed. Patients were followed up in hospital, outpatient department or by telephone. Engel classification was used to evaluate the prognosis, and the operative complications were observed. ResultsAll the 23 patients were followed up at 3, 6, 12 and 24 months after surgery. By the last follow-up, 12 patients were seizure free (Engel grade Ⅰ), 5 patients had rare seizures (Engel gradeⅡ), 5 patients had seizure reduced by 75% (Engel grade Ⅲ), and 1 patient had a <75% seizure reduction (Engel grade Ⅳ). Two patients developed restorable deep sensory disturbance or motor aphasia after operation, all recovered within 1 month, without permanent neurological dysfunction. ConclusionAs a minimally invasive, safe and effective treatment for the drug-resistant insular epilepsy patients, SEEG-guided multiple electrode stereo-conformal radiofrequency thermocoagulation can be a complementary treatment for resection surgery.