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目的探讨机器人辅助无框架定位颅内电极埋植后行长程视频脑电图(VEEG)监测定位癫癎起源灶的方法及效果。方法对19例顽固性癫癎病人采用机器人辅助无框架定位进行颅内深部电极埋植。其中15例术前无法定位致癎灶者均明确癫癎起源灶所在脑叶,4例术前检查提示为单侧颞叶癎性放电者证实为颞叶起源灶。根据监测结果,采用开颅手术3例,立体定向脑内致癎灶毁损术10例,伽玛刀治疗6例。结果术后疗效按Engel分级:Ⅰ～Ⅱ级7例,Ⅲ级6例,Ⅳ级5例,Ⅴ级1例。结论机器人辅助无框架定位颅内电极埋植定位癫癎起源灶的方法具有简单、微创等特点,适用于头皮EEG无法定位者,尤其是对颞叶癫癎的起源灶定侧与定位具有重要价值。
Objective To investigate the method and effect of long-range video electroencephalography (VEEG) for monitoring the origin of epilepsy after robot-assisted frameless intracranial implantation. Methods Nineteen patients with refractory epilepsy were instrumented with robotic frameless intracranial deep electrode implantation. Among them, 15 cases were unable to locate the focus of preoperative brain lesions were located in patients with epilepsy brain lesions, 4 cases of preoperative examination showed unilateral temporal lobe 证 discharge confirmed as temporal lobe foci. According to the monitoring results, craniotomy was performed in 3 cases, stereotaxic brain lesions in 10 cases and gamma knife in 6 cases. Results The postoperative efficacy according to Engel classification: Ⅰ ~ Ⅱ grade in 7 cases, Ⅲ grade in 6 cases, Ⅳ grade in 5 cases, Ⅴ grade in 1 case. Conclusion The method of locating intracranial electrodes with robotic-assisted frameless intracranial electrodes for the localization of epilepsy has the characteristics of simple and minimally invasive, and is applicable to those who can not locate the scalp EEG, especially for the origin and location of temporal lobe epilepsy value.