神经导航结合术中皮质电刺激在局灶性皮质发育不良癫手术中的应用

目的探讨神经导航结合术中皮质电刺激(CES),在局灶性皮质发育不良(FCD)癫手术中的应用。方法对18例FCD癫病人行MRI薄层扫描及血氧水平依赖性功能磁共振成像(BOLD-fMRI)扫描,结合神经导航引导手术入路,CES定位运动区,皮质脑电图定位致灶,行致灶加病灶切除。结果术后病人肢体运动功能均与术前相同,病理结果均为FCD。术后随访1年,Engel分级:Ⅰ级14例,Ⅱ级2例,Ⅲ级1例,Ⅳ级1例。复查脑电图较术前明显改善,棘波、尖波基本消失。结论神经导航结合BOLD-fMRI、CES及皮质脑电图,在FCD癫手术中定位准确,减少运动功能损伤,达到癫灶切除及最大程度保护运动功能的目的。

Application of neuronavigation combined with intraoperative cortical electrical stimulation in the surgery for focal cortical dysplasia-associated epilepsy

Objective To investigate the application of neuronavigation combined with intraoperative cortical electrical stimulation（CES） in the surgery of focal cortical dysplasia（FCD）-associated epilepsy.Methods Eighteen patients with FCD epilepsy were examined by MRI thin slice scan and blood-oxygen-level-dependent functional MRI（BOLD-fMRI）.Epileptogenic focus resection was guided by neuronavigation,combined with the localization of motor area by intraoperative CES and epileptogenic focus by cortical electroencephalogram.Results The motor function of all the patients were the same as preoperation,and FCD were confirmed by pathology in 18 patients.All the patients were followed up for 1 year,and the results were grade Ⅰ in 14 cases,Ⅱ in 2,Ⅲ in 1,Ⅳ in 1 according to Engel classification.The electroencephalogram showed the spike wave and sharp wave essentially disappeared,and significantly improved as compared with preoperation.Conclusions By the neuronavigation combined with BOLD-fMRI,CES and cortical electroencephalogram,epileptogenic focus can be positioned accurately in the surgery of FCD epilepsy to decrease the damage of body motor function,which achieves resection of epileptogenic focus and the most effective protection of motor function.