颅内埋藏电极长程视频脑电图在儿童癫痫外科中的应用

目的：探讨颅内脑电图（intracranialEEG，iEEG）监测在儿童癫痫外科中的应用。方法：无创检查致痫灶定位困难的顽固性癫痫患儿57例，采用颅内硬膜下和（或）颅内深部电极，长程视频iEEG监测。其中10例于电极埋藏后进行慢性电刺激以定位功能区和（或）诱发癫痫发作。根据术中放电情况、电刺激后发放、术后病理结果及疗效分析iEEG定位致痫灶的价值。结果：57例中39例（68％）iEEG致痫灶为局灶性或单侧性起源，11例（19％）明确为双侧起源但以一侧优势，6例致痫灶起源仍判断困难，另1例因其他原因终止检测未行定位。50例接受开颅手术治疗，39例行致痫灶切除手术，11例在切除优势侧致痫灶的同时加做胼胝体前部切开术。术后随访1～3年，疗效按Engel的标准评定，效果优良（EngelI＋Ⅱ级）为82％（41／50），无严重并发症发生。结论：对于头皮EEG等无创性检查不能明确致痫灶的病例，iEEG是一种安全可靠的致痫灶定位方法，并可以联合脑功能区的定位，在保证手术效果的同时，降低神经功能障碍的发生。

Application of long-term EEG monitoring with intracranial electrodees in surgery on children with intractable epilepsy

Objective： To explore the application of long-term EEG monitoring with tracranial elec- trodes in surgery on chidren with intractable epilepsy. Methods：57 pediatric patients with intractable epi- lepsy,whose seizure onsets were unable to be located by MRI received tong-term video-iEEG moritoring with subdural and/ or depth electrodes. 10 of the patients were performed chronic subdural electrostimu- lation in 10 cases to locale the functional area and/ or induce clinical seizures. Epileptogenic zones were determined according to the performances of long-term video iEEG. The accuracy for location of epilept0- genic zones were evaluated based on the data of iEEG monitoring, after discharge, pathological examina- tion and clinical follow-up. Results：Focal epileptic discharge was indicated in 39 patients（68%） for ablative surgery, 11 cases（19%）were lateralized of multifocuses in bilateral hemisphere with corpus callosotomy extras. 6 cases were hard to be identified, and 1 patient stopped monitoring without operation for some other reasons . During the follow-up for 1-3 years,41 out of 50 patients belonged to Engel Class I -- II outcome after surgery without complication. Conclusion： It is a safe and effective way to locate epilepto- genic zones and functional areas with iEEG. It can increase the ＇effect of operation and reduce the neuro- logic disability.