脑裂畸形继发难治性癫的微创外科治疗

目的探讨脑裂畸形继发难治性癫的致灶定位以及微创外科治疗方法。方法回顾性分析11例脑裂畸形继发难治性癫病人的临床资料,术前通过多模态神经影像和长程视频脑电图进行解剖与功能定位。在神经导航引导下使用皮质电极描记了解脑裂畸形病灶与癫波的关系,显微镜下将脑裂畸形的致灶切除。其中位于功能区的脑裂畸形,可使用功能MRI(fMRI)导航并辅以小功率皮质热灼。结果随访11例,时间12个月。术后癫发作完全消失9例,好转2例。结论多模态神经影像和长程视频脑电图可以对脑裂畸形继发的难治性癫进行致灶的解剖与功能定位,在保护脑功能的基础上将脑裂畸形的致灶切除是手术关键。

Minimally invasive surgery for intractable epilepsy secondary to schizencephaly

Objective To explore the localization of epileptogenic loci and minimally invasive surgery for intractable epilepsy secondary to schizencephaly. Methods Clinical data of 11 patients with intractable epilepsy secondary to schizencephaly were analyzed retrospectively. The preoperative multi-modal neuroimaging and long-term video-EEG （VEEG） monitoring were used to localize anatomical and functional areas of epileptogenic loci. The electrocorticography guided by neuronavigation system was used to identify the relationship between the schizencephaly lesion and epileptogenic wave. The epileptogenic loci were resected under microscope. The functional MRI （itVlRI） neuronavigation and low-power cortex thermocoagulation were performed for the schizencephaly localized in functional areas. Results Eleven patients were followed up for 12 months. Epileptic seizure completely disappeared in 9 patients and improved in 2. Conclusions The epileptogenic loci of intractable epilepsy secondary to schizencephaly can be anatomically and functionally localized accurately by the application of multi-modal neuroimaging and VEEG. The protection of brain function is crucial for the resection of epileptogenic loci due to schizencephaly during surgery.