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目的探讨难治性癫痫三级脑电监测及显微手术干预的临床效果。方法对30例难治性癫痫患者进行常规头皮脑电图(EEG)和动态视频脑电图(VEEG)监测,结合CT、MRI、ECT影像表现,进行综合性评估,确定致痫灶;术中皮层脑电图(ECoG)及深部电极脑电图(DEEG)监测癫痫放电区域,麻醉唤醒后,皮层及深部电刺激验证,对孤立性癫痫病灶行显微手术切除,对多灶性或双侧独立的癫痫灶行胼胝体切开术,对位于皮质功能区癫痫灶行软脑膜下横切(MST)。结果 30例难治性癫痫患者术后Engel分级:Ⅰ级19例,Ⅱ级10例,Ⅲ级1例,无Ⅳ级病例。所有患者术后无永久性神经功能缺失,无语言记忆功能障碍。结论 VEEG+MRI+ECT+ECoG或DEEG组合评估,对难治性癫痫致痫灶定位准确,显微手术后疗效良好。
Objective To investigate the clinical effect of tertiary electroencephalogram (EEG) monitoring and microsurgical intervention on intractable epilepsy. Methods Thirty patients with intractable epilepsy were screened by routine scalp electroencephalography (EEG) and dynamic video electroencephalography (VEEG). CT scans, MRI and ECT were performed to evaluate the results. Electro-cortical (ECoG) and deep electrode electroencephalography (DEEG) were used to monitor the area of epileptic discharge. After anesthesia awakening, cortical and deep electrical stimulation were performed. Microsurgical resection of solitary epilepsy lesion was performed. An independent epileptic lesion was performed by corpus callosotomy and transectional submetasthetic transection (MST) was performed in the epileptogenic zone of the cortical zone. Results Engel grade was found in 30 patients with refractory epilepsy after operation: 19 cases of grade Ⅰ, 10 cases of grade Ⅱ, 1 case of grade Ⅲ, and no case of grade Ⅳ. All patients had no permanent loss of neurological function and no speech dysfunctions. Conclusions The combination of VEEG + MRI + ECT + ECoG or DEEG is accurate and accurate in the treatment of intractable epilepsy, and has a good effect after microsurgery.