局灶性皮质发育不良所致难治性癫痫的微创神经外科治疗

目的应用神经导航结合术中皮质电极描记,微创治疗局灶性皮质发育不良(focal cortical dysplasia,FCD)所致的难治性癫痫。方法 26例局灶性皮质发育不良所致的难治性癫痫患者,术前常规使用CT、磁共振成像(magnetic resonanceimaging,MRI)、长程视频脑电图(digital video signal and electroencephalogram,VEEG)、磁共振波谱分析(MR Spectroscopy,MRS)等检查,如病灶位于功能区则行功能性磁共振成像(functional magnetic resonance imaging,fMRI)。术中通过神经导航确定的病灶与ECoG确定的致痫灶位置及范围进行对比,了解两者的吻合程度及差异,综合分析后精确并标记出癫痫波的起源位置和范围,将局灶性皮质发育不良病灶和周边的致痫皮质切除;如致痫灶位于功能区或附近,在保留功能区皮质的基础上,给予低功率皮质热灼。结果术后病理结果:26例患者病理标本符合FCD。术后患者无明显并发症出现。根据Engel术后效果分级进行评估,Ⅰ级23例,Ⅱ级2例,Ⅲ级1例。结论神经导航结合术中皮质电极描记在局灶性皮质发育不良所致的难治性癫痫手术中,具有定位准确、损伤少的优点,在切除致痫灶的同时能最大程度保护脑功能。

Minimally invasive neurosurgical treatment of focal cortical dysplasia-associated refractory epilepsy

Objective To report the minimally invasive surgical treatment of focal cortical dysplasia(FCD)-associated refractory epilepsy by neuronavigation combined with intraoperative electrocorticogram(ECoG).Methods 26 patients with FCD epilepsy were routinely examined by CT,magnetic resonance imaging(MRI),vedio-electrocorticogram(VEEG),MR spectroscopy(MRS),etc preoperatively.Patients were undergone functional magnetic resonance imaging(fMRI) if epileptogenic focus located in the eloquent areas.During surgery,compared the results of neuronavigation and ECoG to learn the consistency between them,comprehensively analyzed of the accurate origin of epileptic wave,the location and extent of epileptogenic focus,resected the FCD lesions and surrounding epileptogenic cortex.Patients underwent lower power electrocoagulation if epileptogenic focus located in the eloquent areas,the eloquent cortex was carefully protected meanwhile.Results FCD was found in postoperative pathological examination in all the 26 cases.According to Engel classification system,23 case of Class Ⅰ,2 case of Class Ⅱ,1 case of Class Ⅲ,and the total cure rate was 88.5%.Conclusions Neuronavigation combined with ECoG for FCD associated refractory epilepsy surgery has the following advantages: accurate localization,less damage.removal of epileptic foci while protecting brain function to the greatest degree.