术中皮层脑电监测并癫痫诱发试验在癫痫手术中的应用

目的 探讨术中癫痫诱发试验对癫痫灶切除的方法和疗效.方法 对118例难治性癫痫患者,在术中首先唤醒患者,利用皮层和深部电极,监测患者的棘波、尖波或棘慢、尖慢复合波等,数码标签标出致痫灶的范围,加深麻醉后手术切除和(或)皮层热灼,再次促醒患者并给予过度换气,使二氧化碳分压(PCO2)在20～25 mmHg,持续5 min,复测脑电波,测得棘波、尖波标记后,再次加深麻醉给予切除和(或)皮层热灼.结果 (1)118例患者中,除3例儿童患者因术中不合作,在较浅的麻醉下完成手术外,115例患者经过麻醉的清醒、过度换气诱发试验后,均顺利完成了手术.术中无一例出现癫痫发作.(2)根据唤醒条件下测得结果,手术后虽然癫痫波基本消失,但经过度换气诱发试验,发现仍有63例再次测出癫痫波,经再次手术后,过度换气诱发,复测癫痫波消失.(3)术后随访:本组无手术死亡,2例不全性运动性失语,术后半年恢复,2例不完全偏瘫术后1年基本恢复,3例胶质细胞瘤患者死亡,5例失访,110例患者得到了随访,时间3-33个月,平均18.5个月.根据Engel术后效果分级进行评估:Ⅰ级74例,Ⅱ级27例,Ⅲ级6例,Ⅳ级3例.结论 术中癫痫诱发试验,在癫痫灶切除术中具有非常重要的指导意义,值得进一步探讨.

Abstract：

Objective To study intraoperative epilepsy inducing test and its effect in the epileptogenic focus resection. Method The study included 118 patients with refractory epilepsy. During surgery, the patients were first woken up. With cortical and depth electrodes, the patient's spike wave, sharp wave or spike slow, sharp slow complex wave, etc. were monitored. The range of epileptogenic foci was marked with digital label. Under deep anesthesia, the foci was resected and the cortex was heat burned. The patients were woken up again, and hyperventilated, the carbon dioxide partial pressure (PCO2) kept at 20～25 mmHg for 5 minutes. The brain waves were measured again. After marking the spike and sharp waves, the anesthesia was deepened again, and resection and cortex heat burning were applied. Results (1)Of the 118 patients, except 3 children performed under light anesthesia because of noncooperation, 115 patients all successfully underwent the surgery, going through consciousness recovery, hyperventilation inducing test after general anesthesia, without intraoperative seizures. (2) According to the results by arousal conditions, despite postoperative epileptic wave basically disappeared, the epileptic waves were still detected in 63 patients after hyperventilation inducing test. The epileptic wave disappeared after repeated operation and hyperventilation inducing test.(3) Postoperative follow - up showed no operative death, incomplete motor aphasia in 2 cases and recovered in 6 months. 2 cases with incomplete paralysis recovered after 1 year. 3 patients with glioblastoma died. 5 patients were not traceable. 110 patients were followed up for 3-33 months (mean 18. 5 months). According to Engel's postoperative evaluation, 74 cases were grade Ⅰ , 27 cases were grade Ⅱ , 6 cases were grade Ⅲ, 3 cases were grade Ⅳ. Conclusions Intraoperative epilepsy inducing test has very important significance in the epileptic focus resection and deserves to further exploration.

The use of cortical electroencehalography monitoring and epilepsy inducing test in epilepsy surgery

Objective To study intraoperative epilepsy inducing test and its effect in the epileptogenic focus resection. Method The study included 118 patients with refractory epilepsy. During surgery, the patients were first woken up. With cortical and depth electrodes, the patient's spike wave, sharp wave or spike slow, sharp slow complex wave, etc. were monitored. The range of epileptogenic foci was marked with digital label. Under deep anesthesia, the foci was resected and the cortex was heat burned. The patients were woken up again, and hyperventilated, the carbon dioxide partial pressure (PCO2) kept at 20～25 mmHg for 5 minutes. The brain waves were measured again. After marking the spike and sharp waves, the anesthesia was deepened again, and resection and cortex heat burning were applied. Results (1)Of the 118 patients, except 3 children performed under light anesthesia because of noncooperation, 115 patients all successfully underwent the surgery, going through consciousness recovery, hyperventilation inducing test after general anesthesia, without intraoperative seizures. (2) According to the results by arousal conditions, despite postoperative epileptic wave basically disappeared, the epileptic waves were still detected in 63 patients after hyperventilation inducing test. The epileptic wave disappeared after repeated operation and hyperventilation inducing test.(3) Postoperative follow - up showed no operative death, incomplete motor aphasia in 2 cases and recovered in 6 months. 2 cases with incomplete paralysis recovered after 1 year. 3 patients with glioblastoma died. 5 patients were not traceable. 110 patients were followed up for 3-33 months (mean 18. 5 months). According to Engel's postoperative evaluation, 74 cases were grade Ⅰ , 27 cases were grade Ⅱ , 6 cases were grade Ⅲ, 3 cases were grade Ⅳ. Conclusions Intraoperative epilepsy inducing test has very important significance in the epileptic focus resection and deserves to further exploration.