皮层电极在脑感觉运动区致痫灶定位中的应用

目的：探讨应用皮层电刺激及体感诱发电位（SEP）等技术以提高脑功能区致痼灶定位的准确性的方法。方法：对病灶涉及感觉运动区的11例癫痫患者，经术前评估后在高度怀疑的致痫区埋藏电极，监测癫痫发作间期及发作期的脑皮层电图（ECoG），同时另行皮层电刺激及SEP的皮层记录，以明确致痫灶起源及感觉功能区定位结果，绘制个体化的脑功能图谱，制定手术切除方案。结果：11例（100％）患者的电刺激与SEP结果相符，其中9例（82％）患者的电生理脑感觉、运动区的定位结果与解剖学定位结果相一致，2例（18％）患者的脑功能定位结果与解剖学定位结果不一致，经MRI结果显示，这2例患者的中央沟附近有异常信号。在皮层电刺激和SEP进行脑感觉运动区定位的基础上进行功能区癫痫病灶的手术切除，术后患者感觉、运动功能完整，并且术后Engel评分均为Ⅰ级。结论：应用颅内电极皮层电刺激术结合SEP对位于脑感觉、运动区的癫痫病灶可准确定位并行切除，提高了癫痫病人的外科治愈率。

The application of intracranial electrodes electrocorticography in detacting the position of epileptogenic zone at the brain sensory and motor areas

Objective： To explore the cortex electrodes technique of cortical electrical stimulation and somatosensory evoked potential, so as to improve the accuracy of location in brain functional areas and avoid possible surgical risks . Methods.. Eleven patients with epilepsy affecting sensory-motor areas were carried out long-term video EEG monitoring after preoperativel assessment. Intraopevative electrocortico- gram（ECoG） of direct cortical electrical stimulation （DCES） and somatosensory evoked potential （SEP） were recorded to determine the source of epilepsy and the location of sensory-motor areas, make functional individual brain function maps and work out a safe surgery treatment. Results： The results of electrical Stimulation were in conformity with SEP in all 11 patients（100%）. Nine（82%） of their functional areas were basically consistent with the anatomical location. MRI in other 2 patients（18%） showed abnormal signal near the central sulcu. The result of DCES and SEP was not in conformity with the anatomical location. The lesion to functional areas over the role led to the displacement. After. operation based on the above test results none of the patients＇ sensory-motor function was damaged. Conclusion： The combination of DCED .technologies and SEP examination is effective for the location and removal of the epilepto- genic zone in the sensory-motor area and can improve the cure rate in patients with epilepsy.