超声引导脑电监测在脑动静脉畸形继发癫痫手术中的应用

目的 探讨超声引导联合皮层脑电图(ECoG)监测在脑动静脉畸形(cAVM)继发癫痫显微手术治疗中的作用和价值。 方法 回顾性分析显微手术治疗的18例cAVM继发癫痫患者的临床资料,术中均采用超声引导及ECoG监测的方法指导cAVM完全切除及致痫灶切除。 结果 术中超声能清晰显示cAVM血管团位置、边界及cAVM的供血动脉、引流静脉情况,指导cAVM血管团完整切除,也有效发现手术残余从而指导补充切除,最终达到cAVM血管团完全切除;术中ECoG可监测到cAVM周围及其远隔部位的痫性放电,有效指导致痫灶合理化处理以减少脑功能的损伤。本组病例术后随访≥2年,无神经功能障碍,癫痫无发作,按照Engel的疗效判断标准,均为EngleⅠ级。 结论 术中超声引导可准确定位cAVM且能判定其供血动脉及残余情况,指导完整切除;ECoG监测确定致痫灶,进一步指导切除范围。二者联合应用能够有效减少脑组织损伤、减少手术并发症,显著提高癫痫治疗效果。

Application of ultrasound-guided electrocorticography monitoring in the microsurgical treatment of epilepsy secondary to cerebral arteriovenous malformation

Objective To explore the role and value of ultrasound-guided electrocorticography(ECoG)monitoring in the microsurgery of epilepsy secondary to cerebral arteriovenous malformations(cAVM). Methods The clinical data of 18 patients with epilepsy secondary to cAVM treated with microsurgery were retrospectively analyzed. During operation, the complete resection of cAVM and epileptogenic zone was under ultrasound guidance and ECoG monitoring. Results Intraoperative ultrasound could clearly show the position, boundary, feeding artery and drainage veins of cAVM; it could identify the surgical remnants so as to guide complete resection of cAVM vascular mass. ECoG could monitor the epileptic discharges and thus reduce injury on brain function. During the follow-up of more than 2 years, no neurological dysfunction or seizure occurred. The efficacy reached Engel I in all cases. Conclusion Intraoperative ultrasound guidance can accurately locate cAVM and determine its feeding artery and residual conditions, guide complete resection; ECoG monitoring determines epileptogenic zone, and further guides the scope of resection. Intraoperative ultrasound guidance combined with ECoG monitoring can effectively reduce complications and brain injury, and significantly improve the therapeutic effects.