术中癫痫诱发试验联合皮层热灼治疗胶质瘤所致癫痫的临床研究

目的 探讨术中癫痫诱发试验联合皮层热灼治疗胶质瘤所致癫痫的方法和效果.方法 连续选择以癫痫为主要临床表现的胶质瘤患者11例,在常规气管插管全麻下首先行肿瘤显微手术切除,然后在皮层脑电图的监测下,对癫痫灶皮层进行低功率双极电凝热灼.待癫痫波完全消失后,采用患者唤醒、过度换气和静脉注射氟马西尼联合进行癫痫诱发试验,同时给予少量肌松药防止抽搐发作.对诱发出的棘、尖波再给予皮层热灼直至完全消失.手术后不再使用镇静药物和抗癫痫药物,并对患者进行术后追踪随访,随访时间为18～20个月.结果 诱发试验能够明显增加脑皮层的电活动和癫痫波的出现频率,而皮层热灼的作用恰好相反.所有患者全部安全度过围手术期,且一般状态恢复较快.除1例在术后接受放疗期间出现一过性右上肢抽搐,又给予抗癫痫药物治疗外,其余患者均未发现癫痫复发的征象.结论 术中癫痫诱发试验联合皮层热灼是治疗胶质瘤所致癫痫的有效方法,并且安全可靠,有必要进行深入的研究.

Epileptic activating techniques combining with Stripe thermo-coagulation for surgical treatment of epilepsy in glioma patient

Objective To study the methods and efficency of epileptic activating techniques combining with stripe thermo-coagulation on the cortexes during the operation for the epilepsies of glioma. Methods 11 consecutive low-grade glioma patients with seizures were treated by craniotomy. The tumors were resected firstly under general endotracheal anesthesia, then under the monitoring of the intra-operative electrocorticography (ECoG), the cortexes with epileptic waves were coagulated by bipolar coagulation (made in Sweden) in low power (5u) for 1~2 seconds across gyri. The span between the two stripes was about 5 mm. Then, the patients were waked up and Bromide was pumped continuously via vein in 0.05 mg/kg/h to prevent seizure attack, and the hyperventilation was used and Flumazenil 0.02 mg/kg was injected via vein. When the epileptic waves appeared again, the cortexes were coagulated again until the spikes disappeared. The sedatives and anticonvulsants were not used after the operations. These patients have been followed up for 18 to 20 months. Results The activation techniques can increase apparently the electrical excitability of cortexes and the frequency of spikes. On the contrary, the stripe thermo-coagulation can decrease them, but do not result in pareses. All patients recovered quickly after the operations. One patient had a focal seizure on the right upper extremity during radiotherapy by one month after operation, whereas no seizures were found in the other patients. Conclusions It is efficient and safe that the epileptic activating techniques combined with stripe thermo-coagulation on the cortexes treats epilepsy suffered from glioma patient, the further research will be necessary.