影像导航下立体定向脑电监测在额叶癫痫中的应用…

目的 探讨影像导航引导下颅内立体脑电图监测在额叶癫痫外科治疗中的作用。方法 选取2014年1月至2016年3月35例定位定侧困难的额叶癫痫，采用美敦力S7导航系统融合MRI影像，根据脑网络在导航下置入电极，术后监测脑电图定位癫痫病灶，手术切除致痫灶。结果 35例均按计划成功置入深部电极，其中单侧12例，双侧23例，均监测到3~20次临床惯常发作。1例定位困难，未手术治疗；其余34例根据脑电图结果行致痫灶切除。置入电极后1例发生硬膜外血肿，量约20 ml，癫痫病灶切除时一并清除；癫痫病灶切除术后1例早期出现单瘫，1例出现运动性失语，经治疗后恢复。34例手术病人术后随访1~3年，Engel分级Ⅰ级24例（70.5%），Ⅱ级5例（14.7%），Ⅲ级4例（11.7%），Ⅳ级1例（2.9%）。结论 影像导航下立体定向脑电图定位癫痫病灶在额叶癫痫的外科治疗是安全、有效的。

Application of stereoelectroencephalography under image-navigation to surgery for frontal lobe epilepsy

Objective To explore the role of stereoelectroencephalography (SEEG) monitoring guided by image navigation in the surgery for frontal lobe epilepsy. Methods It was difficult to localize the epileptic focuses in 35 patients with front lobe epilepsy treated in our department from January, 2014 to March, 2016. The patients’ brain MRI images were fused into Medtronic S7 navigation system and the stereotactic electrodes were implanted into the brains under the image-navigation. The epileptogenic zone was localized according to SEEG monitoring and resected by surgery. Postoperative follow-up time ranged from 1 to 3 years and the effects of epileptic control were evaluated by Engel’s classification. Results The deep electrodes were implanted according to the peroperative plan in 35 patients, of whom, 12 received the unilateral implantations of electrodes and 23 bilateral implantations. The clinical usual attacks were detected in all the patients and the number of the attacks ranged from 3 to 20 times. After comprehensive assessment, the surgery was not performed in a patient because the epileptic focus was difficult of localization, and the epileptic focuses were successfully resected in the rest 34 patients according to the assessment results. After electrodes implantation, one patient had epidural hematoma of 20 ml which was removed by the surgery. After the surgery, one patient had transient unilateral paralysis in the early stage and one had motor aphasia which was cured by the treatment. The effect of epileptic control was Engel’s class Ⅰ in 24 patients (70.5%), class Ⅱ in 5 (14.7%), class Ⅲ in 4 (11.7%) and Ⅳ in 1 (2.9%). Conclusion It is safe and effective to apply SEEG under image-navigation to location of the epileptic lesions in the patients with frontal lobe epilepsy.