额叶癫痫致痫灶综合评估定位及手术治疗

目的 分析额叶癫痫临床和术前各项辅助检查资料,结合术中脑电监测及手术疗效来评价致痫灶的定位及对手术的指导.方法 2005至2009年于天津医科大学总医院对23例额叶癫痫患者行AEEG、VEEG检测和头MRI检查,其中17例行发作问期18F-FDG-PET-CT检查,11例行MEG检查,2例行功能磁共振检查(fMRI),10例行手术治疗并行术中ECoG及DEEG监测.分析临床发作特征及各种检查对致痫灶定位的价值,比较EEG和MEG痫性放电与致痫病灶的一致性,对额叶致痫灶的部位、手术方式及术后转归进行比较分析.结果 发作的症状、发作间期EEG、发作期EEG、MRI和PET-CT检查有致痫灶定位意义的结果分别为56.52%、56.52%、60.87%、54.55%和94.12%,各项结果一致时对定位有帮助;MEG比EEG的定位更精确;术中ECoG及DEEG监测对手术治疗的范围有指导意义.结论 额叶癫痫的致痫灶定位应坚持综合检查评估定位方法,手术疗效取决于术前定位的准确性及致痈灶能否完全切除.

Localization of epileptic foci in frontal lobe epilepsy and its surgical therapy

Objective To analyze the clinical data and pre-operative examination results of frontal lobe epilepsy and combine with intra-operative intraeranial electrical record in order to localize epileptic loci and to direct surgical therapy.Methods Preoperative EEG record and MRI scan were performed in 23 patients with refractory frontal lobe epilepsy.Among them,17 patients received interictal 18F-FDG-PETCT,11 received MEG examination,2 received functional MRI,10 received surgical operation and intraoperative intracranial electrical record.Results The positive predictive value of clinical features of epileptic seizure,interictal EEG,ictal EEG,MRI and PET-CT were 56.52%,56.52%,60.87%,54.55% and 94.12% respectively.Their consistent results helped to confirm the epileptogenie zone.MEG was more accurate than EEG.ECoE and VEEG monitoring was significant for operative guidance.Conclusion A series of examinations is necessary for the diagnosis of epileptogenic zone of frontal lobe epilepsy.The surgical outcome is related to the accuracy of epileptic loci localization and the removal of epileptogcnic zone.