中央区纵裂癫的诊疗探讨

目的探讨中央区纵裂癫的诊治经验。方法回顾性分析6例癫病人的临床资料,术前均进行评估,包括临床表现、MRI、视频脑电图(VEEG)、加密电极、埋藏电极和(或)皮质脑电图(ECoG)、脑磁图(MEG)检查,确诊为中央区纵裂癫。通过皮质电刺激、立体定向引导、术中唤醒等方法,明确致灶、功能区的范围及相互位置关系,在皮质脑电图监测下行显微手术切除致灶。结果病变手术全切除3例,大部分切除3例。术后均无出血、感染等并发症出现,无麻醉意外发生。术后病理结果为:胶质增生1例,局灶性皮质发育不良Ⅱa1例、Ⅱb2例,脂肪瘤1例,海绵状血管瘤1例。随访6例,时间13～23个月,根据Engel分级:Ⅰ级5例,Ⅱ级1例。结论中央区纵裂癫表现特异,确诊后在精确定位致灶、功能区情况下,选择手术治疗,效果理想。

Diagnosis and treatment of epilepsy in diastema of central area

Objective To explore the experiences with diagnosis and treatment of epilepsy in diastema of the central area. Methods Clinical data from 6 patients with epilepsy were analyzed retrospectively. The preoperative evaluation was made for six patients including clinical manifestation, MRI, video-electroencephalogram （VEEG）, encrypted electrode, implanted electrode and/or electrocorticography （ECoG） and magnetoencephalogram （MEG）, and they were diagnosed as having epilepsy in the diastema of the central area. Electrical stimulation of the cortex, stereotactic guidance and intraoperative awakening were used to confirm the epileptogenic focus, extent of the eloquent area and the relationship between the eloquent area and epileptic focus. The epileptogenic lesion was mierosurgically resected with electrocorticogram monitoring. Results Total lesion removal was achieved in 3 cases and subtotal removal in 3. No postoperative bleeding, infection and anesthetic accident occurred. The lesions were diagnosed by postoperative pathological analysis, including 1 gliosis, 1 focal cortical dysplasia in grade Ⅱa and 2 in grade Ⅱ b, 1 lipomyoma and 1 cavernous hemangioma. Six patients were followed up for 13 to 23 months： grade I in 5 patients and grade Ⅱ in Ⅰ according to Engel classification. Conclusions Epilepsy in diastema of the central area has its own particular presentation and can be treated by surgery with an ideal outcome if there is a precise location of the focus and eloquent area.