颅内电极脑电监测定位致癇灶

目的探讨颅内埋置电极脑电图(iEEG)监测定位致灶的意义及其安全性。方法对38例经无创方法难以定位的难治性癫病人,采用颅骨钻孔或骨瓣开颅方法埋置硬膜下和(或)深部电极,行长程视频脑电监测定位致灶。根据术中致灶定位、术后病理、术后疗效和EEG复查结果分析iEEG监测定位致灶的准确性。结果8例埋置深部电极,13例埋置硬膜下电极,17例联合应用硬膜下电极和深部电极。颅内电极埋置4～22d,平均9d;脑电监测8～226 h,平均128h。根据癫发作初始期iEEG,32例(84.2%)病人准确定位了致灶,无颅内出血和感染等严重并发症发生。结论选择性应用硬膜下和深部电极长程视频脑电监测是一种安全、有效的检查方法;癫发作初始期异常放电的节律和范围是可靠的致灶定位指标。

A study on intracranial EEG monitoring for localizing epileptogenic zone

Objective To investigate the role and safety of intracranial EEG (iEEG) monitoring for localizing epileptogenic zone in patients with intractable epilepsy. Methods The subdural and depth electrodes were implanted in 38 cases. Epileptogenic zones were determined according to the performances of long-term iEEG. The accuracy for localization of epileptogenic zones was evaluated based on the data of iEEG monitoring, pathological examination, postoperative EEG recordings and clinical follow-up. Results Subdural electrodes were used in 8 cases, depth in 13, both subdural and depth in 17. The iEEG monitoring lasted from 8 to 226 hours (mean 128 hours). Epileptic activities were detected at the initial stage of seizures (n =373) in all of 38 patients and 84.2% (32/38) were accurately localized. No significant complication was observed. Conclusion The implantation of subdural and depth electrodes is a safe and effective method to localize epileptogenic zones in selected patients. The patterns and extents of the initial ictal EEG discharges are reliable information for localizing epileptogenic zone.