论文部分内容阅读
目的研究在颞叶以外癫痫的诊疗中,脑磁图对颅内电极置入方案的指导价值。方法自2011年3月至2013年9月,对将行颅内电极置入的顽固性癫痫患者评估,先在电-临床症状学、影像学、脑电图等结果的基础上设计出初步的颅内电极埋置方案,然后添加MEG定位信息,并根据MEG调整电极埋置方案,得出最终颅内电极置入计划。继而行颅内脑电图监测并行手术治疗。最后分析颞叶以外癫痫中,脑磁图对颅内电极置入方案的指导价值。结果成功定位癫痫发作起始区并完成手术治疗、且经颅内电极证实为颞叶以外癫痫(NTLE)者有22例。9例(40.1%)患者MEG对iEEG电极置入方案产生额外于其它常规评估手段的指导作用(因MEG而增加电极覆盖),其中7例(31.8%)经iEEG证实这些增加的定位信息与发作起始区一致。术后平均随访33.3个月:EngelⅠ级14例(63.6%),EngelⅡ级3例(13.6%),EngelⅢ级3例(13.6%),EngelⅣ级2例(9.1%)。结论区别于视频脑电图、MRI等其它的无创检查,MEG能够对有创的iEEG电极埋置方案起到额外指导作用,能使电极埋置更合理精确、有针对性,并可能提高癫痫手术的疗效。
Objective To study the guiding value of magnetoencephalography in intracranial electrode placement in the treatment of epilepsy outside the temporal lobe. Methods From March 2011 to September 2013, we evaluated the patients with intractable epilepsy who had intracranial electrodes inserted. Based on the results of electro-clinical symptoms, radiology and electroencephalography, the preliminary Intracranial placement of the intracranial electrodes followed by MEG positioning and adjustment of the electrode placement scheme based on MEG resulted in a final intracranial electrode placement plan. Followed by intracranial EEG monitoring and surgical treatment. In the end, we analyzed the guiding value of intracranial electrode placement in cerebral epilepsy outside temporal lobe. Results The onset of epileptic seizure was successfully located and surgery was completed. Twenty-two patients with epilepsy outside the temporal lobe were confirmed by intracranial electrodes. In 9 (40.1%) patients, the placement of the MEG on the iEEG electrode produced additional guidance for other conventional assessment methods (increased electrode coverage due to MEG), of which 7 (31.8%) were confirmed by iEEG. These increased positioning information and onset The starting area of the same. The average follow-up time was 33.3 months: 14 cases (63.6%) of EngelⅠ, 3 cases (13.6%) of EngelⅡ, 3 cases of EngelⅢ (13.6%) and 2 cases of EngelⅣ (9.1%). Conclusion Different from other noninvasive examinations such as video electroencephalography and MRI, MEG can play an additional guiding role in the invasive iEEG electrode embedding scheme, which can make the electrode embedding more reasonable, accurate and targeted, and may improve epilepsy surgery Efficacy.