颅内电极脑电图监测对枕叶致痫灶的定位价值

目的：探讨颅内电极埋藏后视频脑电图（V-EEG）监测对枕叶致痫灶的定位价值。方法：对19例经无创方法难以定位致痫灶的药物难治性枕叶癫痫（OLE）病人，开顷埋置硬脑膜下条状、栅格状电极和深部电极，行V-EEG监测，记录发作间期及发作期脑电图（EEG）变化，确定发作起源区，再手术切除致痫灶。结果：16例埋置硬脑膜下电极，3例联合应用硬脑膜下电极和深部电极。颅内电极V-EEG监测36～192h（平均68h），均记录到发作间期痫样放电及发作期EEG情况。行枕叶致痼灶切除术后，平均随访24个月，13例发作消失（EngelⅠ级），4例偶发（EngelⅡ级），2例发作减少75％以上（EngelⅢ级）。结论：在致痫灶定位困难的顽固性OLE中，开颅埋藏硬脑膜下电极、深部电极，行V-EEG监测，根据癫痫发作初始期异常放电的节律和范围，可精确定位致痫灶。

The role of intracranial monitoring in the location of epileptogenic fuci in occipital lobe epilepsy

Objective：To explore the role of long term video electroencephalogram （V-EEG） montoring by intracranial electrode implantation for locating epileptogenic loci in patients with occipital lobe epilepsy（OLE）. Methods： The subdural strip, grid and depth electrodes were implanted in 19 patients with refractory OLE, whose seizure onsets were hardly located by non-invasive evaluation. Changes during the onset or in the interval time were recorded to locate seizure onset loci which were resected by surgery. Results.. The subdural electrodes were used in 16 patients with OLE,and the subdural and depth electrodes in 3. The intracranial （iEEG） monitoring lasted from 36 to 192 hours （average 68 hours）. Interictal epileptic discharges were recorded and ictal were obtained in all patients. After a mean follow-up of 24 months, 13 patients were seizure free （68.4% Engel Class Ⅰ）, 4 rarely had seizures （21.1%Engel Class Ⅱ）, and seizures of 2 cases decreased by more than 75 % （10.5 % Engel Class Ⅲ）. Conclusions：The implantation of subdural and depth electrodes is a safe and effective method to locate epileptogenic foci in patients with refractory OLE. The patterns and extents of the initial ictal discharges are reliable information for locating epileptogenic foui.