颅内电极在语言功能区相关癫癎灶手术中的应用

目的探讨颅内电极在语言功能区相关癫癎灶手术中的应用。方法回顾性分析66例涉及语言功能区的癫癎病人的临床资料,在颅内电极监测确定癫癎灶位置之后,应用皮质电刺激技术确定语言功能区位置,二者结合制定手术方案后进行外科手术治疗。结果 11例癫癎起始区与癫癎灶部分重叠,32例皮质电极癫癎起始区与语言功能区邻近（0-1.5 cm）,23例皮质电极癫癎起始区与语言功能区相近（1.6-3.0 cm）。行前颞叶与内侧结构切除术33例,额叶癫癎灶切除术15例,多脑叶切除术16例,选择性海马切除术2例。术后5例病人出现短暂语言功能障碍,均于3个月内恢复。术后随访时间1.5~8年,术后EngelⅠ级46例（70%）,EngelⅡ级8例（12%）,EngelⅢ级7例（11%）,EngelⅣ级5例（7%）。结论颅内电极置入后的皮质脑电图监测及皮质电刺激语言功能区的定位为癫外科精确切除癫癎灶同时保护语言功能提供保证。

Application of intracranial electrode implantation for resection of epileptogenic zone involving language area

Objective To explore the application of intracranial electrode implantation in resection of epileptogenic zone involving language area. Methods Clinical data of 66 patients with epileptogenic zone involving language area were analyzed retrospectively, who underwent intracranial electrode implantation. The location of epileptogenic zone was confirmed by intracranial electrode monitoring and language area by language electric cortical stimulation. Based on the localization results, the surgery plan was made and executed. Results The initial region of epilepsy and epileptogenic zone partially overlapped in 11 patients, and the initial region of epilepsy detected by electrocorticogram was closely adjacent （0 to 1.5 cm） to the language area in 32 patients and located close （1.6 to 3.0 cm） to the language area in 23 patients. The anterior temporal lobe and medial structure were resected in 33 patients, epileptogenic zone of frontal lobe was resected in 15, multiple cerebral lobes were resected in 16, and selective amygdalohippocampectomy was performed in 2. The transient speech dysfimction was observed in 5 patients, who recovered within 3 months. The follow-up period for 1.5 to 8 years revealed that Engel class I was achieved in 46 patients （70%）, class Ⅱ in 8 （12%）, class Ⅲ in 7 （11%） and class IV in 5 （7%）. Conclusion Electrocorticogram monitoring and epileptogenic zone localization with intracranial electrodes are very useful for accurate resection of epileptogenic zone involving language area and protection of language in epilepsy patients.