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目的探索深部电极引导伽玛刀治疗颞叶内侧癫痫的方法,初步评价治疗效果。方法治疗21例颞叶内侧癫痫患者,其中男性13例,女性8例,年龄18~59岁,平均34.2岁,病史3~20年,平均13.5年。用无框架立体定向机器人技术进行深部电极植入,并进行深部电极长程视频脑电监测。本组双侧植入5例,单侧植入16例,植入监测时间1~7天,平均监测2.2天。明确致痫灶后,安装头架,行头颅CT扫描定位,然后拔除深部电极,行头颅核磁扫描。对头颅CT与核磁进行融合,明确致痫灶接触电极的位置,进行伽玛刀治疗。治疗剂量:周边剂量8~13 Gy,平均9.8 Gy;中心剂量16~26 Gy,平均18.2 Gy;50%等剂量曲线。结果随访6~36个月,平均15个月,Engel’s效果分级:Ⅰ级2例,Ⅱ级4例,Ⅲ级9例,Ⅳ级6例(Ⅰ~Ⅲ级为治愈及有效)。有效率为71.4%。手术并发症:颅内积气2例,1周后自行吸收。无其他手术并发症。结论颞叶内侧癫痫深部电极探测明确致痫灶后,应用CT及核磁融合技术,在深部电极引导下进行伽玛刀低剂量治疗,初步治疗结果满意。
Objective To explore the method of deep electrode-guided gamma knife treatment of medial temporal lobe epilepsy and to evaluate the therapeutic effect. Methods Twenty-one cases of temporal lobe medial epilepsy were treated in this study. There were 13 males and 8 females, aged from 18 to 59 years (average 34.2 years) with a history of 3 to 20 years (average 13.5 years). Deep frame electrode implantation was performed with frameless stereotactic robot technique and deep electrode EEG monitoring was performed. The group bilateral implantation in 5 cases, 16 cases of unilateral implantation, monitoring time of 1 to 7 days, the average monitoring of 2.2 days. Clear epileptogenic lesions, the installation of the first frame, line head CT scan positioning, and then remove the deep electrode, line head MRI. Fusion of cranial CT and nuclear magnetic resonance, clear epileptogenic contact with the electrode location, gamma knife treatment. Therapeutic dose: the peripheral dose of 8 ~ 13 Gy, an average of 9.8 Gy; central dose of 16 ~ 26 Gy, an average of 18.2 Gy; 50% isodose curve. Results The patients were followed up for 6 to 36 months with an average of 15 months. The Engel’s effect was graded as follows: grade Ⅰ in 2 cases, grade Ⅱ in 4 cases, grade Ⅲ in 9 cases, and grade Ⅳ in 6 cases (grades Ⅰ-Ⅲ were cured and effective). The effective rate is 71.4%. Surgical complications: 2 cases of intracranial gas, self-absorbed after 1 week. No other surgical complications. Conclusions After detecting the deep epileptic foci in the medial temporal lobe of epilepsy, CT and MRI were used to detect the epileptogenic lesions. The low-dose Gamma Knife treatment was performed under the guidance of deep electrodes. The results of the initial treatment were satisfactory.