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目的:探讨质子磁共振波谱(1H-MRS)分析结合128导视频脑电图(VEEG)、术中皮层或深部电极脑电图(ECoG)对致痫灶定侧定位的价值。方法:选择15例顽固性癫痫为研究对象。术前行VEEG后行H-1MRS检查,获得NAA/(Cr+Cho)比值。术中行ECoG描记验证。以术后病理为标准,将异常放电区域、伴海马硬化的术前H-MRS与同患者对侧检查结果进行对照,分析H-MRS与皮层异常放电的关系。结果:病理回报1115例均有皮质发育不良,海马硬化9例。切除病灶前行病灶周边ECoG描记,15例均发现异常放电。术中ECoG异常放电区域NAA/(Cr+Cho)平均比值为0.78±0.27,同一患者对侧比值为0.94±0.22,差异有显著性意义(P<0.05)。伴海马硬化者NAA/(Cr+Cho)平均比值为0.55±0.14,同一患者对侧比值为0.71±0.09,差异有显著性意义(P<0.05)。1H-MRS与VEEG一致率为86.67%。结论:1H-MRS可对海马硬化进行早期诊断,提高了海马硬化诊断的敏感度。H-MRS结合128导VEEG可提高致痫灶定位的准确性。1
Objective: To investigate the value of proton magnetic resonance spectroscopy (1H-MRS) combined with 128-lead video electroencephalography (VEEG), intraoperative cortex or deep electrode electroencephalogram (ECoG) Methods: Fifteen patients with refractory epilepsy were selected as the research object. H-1MRS was performed before VEEG and NAA / (Cr + Cho) ratio was obtained. Intraoperative ECoG tracing validation. According to postoperative pathology, H-MRS with abnormal discharge area and hippocampal sclerosis were contrasted with contralateral examination results of the same patients to analyze the relationship between H-MRS and abnormal cortical discharge. Results: The pathological findings of 1115 cases had cortical dysplasia, hippocampus sclerosis in 9 cases. Excision of lesions around the ECoG tracing lesions, 15 cases were found to abnormal discharge. The average ratio of NAA / (Cr + Cho) was 0.78 ± 0.27 in the area of abnormal ECoG discharge and 0.94 ± 0.22 in the same patient. The difference was significant (P <0.05). The average ratios of NAA / (Cr + Cho) in hippocampal sclerosis patients were 0.55 ± 0.14, and the contralateral ratio of the same patient was 0.71 ± 0.09, with significant difference (P <0.05). The coincidence rate of 1H-MRS and VEEG was 86.67%. Conclusion: 1H-MRS can early diagnose hippocampal sclerosis and improve the sensitivity of hippocampal sclerosis diagnosis. H-MRS combined with 128-lead VEEG can improve the accuracy of the localization of the focal area. 1