SEEG引导下手术治疗药物难治性癫痫的安全性及有效性

目的 探讨立体定向脑电图（SEEG）引导下手术治疗药物难治性癫痫（DRE）的安全性及有效性。方法 回顾性分析2018年8月至2020年8月SEEG引导下手术治疗的34例DRE的临床资料。SEEG引导下射频热凝损毁术（RF-TC）治疗28例，RF-TC无效而行致痫区切除术11例，SEEG引导下行致痫区切除术6例。34例术后随访14.0~39.3个月，平均（25.2±7.9）个月。结果 28例在SEEG引导下进行RF-TC，术中未出现不适，术后未出现颅内出血，术后4例出现功能障碍；单纯行SEEG引导下RF-TC治疗17例中，癫痫发作完全缓解11例，有效3例，无效3例。11例RF-TC后行致痫区切除术后，3例出现功能障碍，1例出现过敏性休克；术后8例无癫痫发作，2例调整药物后未再出现癫痫发作，1例术后癫痫发作减少60%~70%。6例SEEG引导下直接行致痫区切除术，术后出现功能障碍2例；术后5例无癫痫发作，1例调整抗癫痫药物后未再出现癫痫发作。结论 SEEG引导下RTFC治疗DRE是一种相对安全、有效的方法；致痫区广泛或RF-TC无效的DRE病人，可在SEEG引导下行致痫区切除术。

Safety and effectiveness of SEEG-guided surgery for patients with drug-resistant epilepsy

Objective To investigate the safety and efficacy of stereoelectroencephalography (SEEG)-guided surgery for the patients with drug-resistant epilepsy (DRE). Methods The clinical data of 34 patients with DRE who underwent SEEG-guided surgery from August 2018 to August 2020 were analyzed retrospectively. Of 34 patients, 28 received SEEG-guided radiofrequency thermocoagulation (RF-TC), 11 received epileptic zones resection (EZR) due to no effectiveness of RT-FC, and 6 received SEEG-guied EZR. The follow up ranged from 14.0 months to 39.3 months, with an average time of (25.2±7.9) moths. Results Of 28 patients undergoing RF-TC, no discomfort occurred during the operation and no intracranial hemorrhage occurred after the operation, and dysfunction occurred in 4 patients after the operation. Of 17 patients unergoing simple SEEG-guided RF-TC, 11 patients had complete seizure relief, 3 were effective and 3 were invalid. Of 11 patients undergoing EZR after RF-TC, 1 patient suffered from anaphylactic shock during the operation and 3 patients suffered from neurological dysfunction after the operation; 8 patients had no epileptic seizures after the operation, 2 had no seizures after drug adjustment, and 1 had 60%~70% reduction of postoperative seizures. Of 6 patients undergoing simple SEEG-guided EZR, 2 patients suffered from neurological dysfunction after the operation; 5 patients had no seizures and 1 had no seizures after drug adjustment. Conclusions SEEG-guided RT-FC is a relatively safe and effective method for the treatment of DRE. For DRE patients with extensive epileptic zones or no effectiveness of RF-TC, SEEG-guided EZR is a good choice.