皮层切除术在治疗伴有原发性脑穿通畸形难治性癫痫的初步应用

目的通过埋藏皮层电极监测脑电，结合皮层电刺激、影像融合技术探讨皮层切除治疗伴原发性脑穿通畸形难治性癫痫的有效性及安全性。方法通过对2例伴有原发性脑穿通畸形难治性癫痫患者埋藏皮层电极，行皮层脑电监测及皮层电刺激定位致痫灶、病灶周围功能区。神经导航系统融合头颅CT、MRI影像，三维可视化致痫灶与脑穿通畸形囊解剖关系，第二次手术行致痫性皮层切除术。结果2例患者均成功埋藏皮层电极，皮层脑电图监测捕获惯常发作，皮层电极准确定位致痫灶、功能区，将多层次数据成功融合。2例患者均成功接受致痫性皮层切除术，1例患者术后随访1年至今，未出现痫性发作（Engle评级I级），另1例患者术后随访1．5年至今，痫性发作持续时间及频率显著减少（Engle评级Ⅱ级），2例患者均未出现明显并发症。结论多手段联合运用精确定位异常放电皮层后行皮层切除术是治疗原发性脑穿通畸形合并难治性癫痫的一种有效、安全的治疗方法。

Preliminary cortical resection trial in the treatment of congenital porencephaly--related drug re- fractory epilepsy

Objective With intracranial EEG monitoring, cortical electrical stimulation and neural image fusion technology, abnormal discharge of cortical had been located and resected in order to investigate efficacy and safety in congenital porencephaly--related drug refractory epilep- sy. Methods 2 cases underwent epidural electrodes implantation, withECoG monitoring, and cor- tical electrical stimulation, we had pointde epileptogenic zone and functional area nearby. After- wards,neural fusion navigation system, CT and which would guide following operation. Results MRI images were used to rebuild 3- D model Two patients were successfully buried cortical e- lectrodes, ECoG captured the clinical onset opportunely, and epileptic focis were precisely located. Both patients were accepted epileptogenic cortical resection successfully. One patient was followed up for 1 year so far, and seizures vanished （Engle Class I）, the other one was followed for 1.5 years now, seizure duration and frequency declined significantly （Engle Class II）, No obvious com- plications had arised. Conclusion With multiply technological means, cortical resection is effective and secure for patients with congenital porencephaly--related drug refractory epilepsy.