本文關(guān)鍵詞：ROSA機(jī)器人輔助系統(tǒng)引導(dǎo)下的顱內(nèi)電極植入術(shù)在癲癇外科的應(yīng)用　出處：《大連醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 癲癇 顱內(nèi)電極 SEEG ROSA 機(jī)器人

【摘要】：目的:通過ROSA機(jī)器人輔助系統(tǒng)引導(dǎo)下的顱內(nèi)電極植入確定致癇灶及皮質(zhì)功能區(qū)指導(dǎo)癲癇外科手術(shù)治療,探討顱內(nèi)電極植入的安全性及有效性。方法:回顧性分析沈陽(yáng)軍區(qū)總醫(yī)院神經(jīng)外科,自2016年8月至2016年12月采用ROSA機(jī)器人輔助系統(tǒng)引導(dǎo)下的顱內(nèi)電極植入的21例藥物難治性癲癇患者,21例患者的發(fā)作類型主要包括:局灶性發(fā)作、全面性發(fā)作,臨床資料包括:一般病史、實(shí)驗(yàn)室檢查、神經(jīng)影像學(xué)檢查、神經(jīng)電生理檢查、神經(jīng)心理檢查、電極置入后癲癇病灶的檢出率、并發(fā)癥及手術(shù)效果。手術(shù)過程:術(shù)前行神經(jīng)影像學(xué)檢查,設(shè)計(jì)電極植入計(jì)劃、植入電極、驗(yàn)證電極植入的準(zhǔn)確性、記錄深部電極腦電圖、根據(jù)腦電圖發(fā)作起源定位癲癇灶、手術(shù)切除病灶。手術(shù)原則:根據(jù)病灶部位、術(shù)前SEEG監(jiān)測(cè)及皮層電刺激結(jié)果,選用不同的手術(shù)方式或聯(lián)合術(shù)式,術(shù)中應(yīng)用皮層電極對(duì)病灶及其周邊檢測(cè),進(jìn)一步確認(rèn)致癇灶和手術(shù)切除區(qū)域范圍。所有病例術(shù)中皮層電極監(jiān)測(cè)致癇灶及其周圍記錄異常放電。在保全患者重要的皮質(zhì)功能區(qū)的前提下,顯微外科手術(shù)下行病灶和(或)致癇灶的切除并在皮層腦電圖(ECo G)監(jiān)測(cè)下進(jìn)行病灶。結(jié)果:21例患者共植入電極195根,平均約9.2根,電極留置顱內(nèi)7-35 d,平均13d;捕捉到臨床發(fā)作2-5次,平均3次。20例患者明確致癇灶,19例患者手術(shù)治療,其中8例患者行顳極、海馬及杏仁核切除術(shù),1例行患者性左側(cè)額葉皮質(zhì)發(fā)育不良切除術(shù),1例患者行右側(cè)顳葉皮質(zhì)發(fā)育不良切除及枕葉離斷術(shù);1例行左頂葉軟化灶及周圍致癇灶切除術(shù);1例行右側(cè)額上回、額中回部分皮質(zhì)及額極切除術(shù);1例行左側(cè)枕葉內(nèi)側(cè)皮質(zhì)切除術(shù);1例左側(cè)額葉囊腫及部分前顳葉切除術(shù);1例行頂下小葉及部分顳葉切除;1例行額下回中后部及部分額蓋切除術(shù);1例行右側(cè)扣帶回中后部切除及胼胝體切開術(shù);1例行右側(cè)額中回后部及部分額上回切除術(shù);1例行右側(cè)緣上回皮層切除及Broca區(qū)軟膜下橫切術(shù)。1例患者拒絕手術(shù),1例患者未明確致癇灶,調(diào)整藥物治療;并發(fā)癥:1例患者顱內(nèi)出血,無神經(jīng)功能缺失癥狀,1例患者皮膚感染,未出現(xiàn)死亡、腦脊液漏及電極折斷等并發(fā)癥;19例手術(shù)患者中術(shù)后隨訪,發(fā)作控制Engel評(píng)級(jí)I級(jí)14例,Ⅱ級(jí)2例,Ⅲ級(jí)3例,Ⅳ級(jí)0例。結(jié)論:ROSA機(jī)器人引輔助系統(tǒng)引導(dǎo)下的顱內(nèi)電極植入術(shù),用于藥物難治性癲癇的術(shù)前評(píng)估,準(zhǔn)確、安全、病灶檢出率高,是一種有效的癲癇灶定位手段。
[Abstract]:Objective: to determine the epileptogenic foci and cortical functional areas under the guidance of ROSA robot assisted system (ROSA) guided intracranial electrode implantation to guide the surgical treatment of epilepsy. To explore the safety and efficacy of intracranial electrode implantation. Methods: the neurosurgery department of Shenyang military region General Hospital was retrospectively analyzed. From August 2016 to December 2016, 21 patients with drug-resistant epilepsy were implanted with intracranial electrodes guided by ROSA robot-assisted system. The attack types of 21 patients mainly included: focal attack, comprehensive attack, clinical data including: general medical history, laboratory examination, neuroimaging examination, neuroelectrophysiological examination, neuropsychological examination. The detection rate, complication and operative effect of epileptic foci after electrode implantation. Operation procedure: preoperative neuroimaging examination, design of electrode implantation plan, electrode implantation to verify the accuracy of electrode implantation. The deep electrode EEG was recorded, the epileptic focus was located according to the origin of EEG, and the lesion was resected. The operative principle: according to the location of the lesion, preoperative SEEG monitoring and cortical electrical stimulation results. Different methods of operation or combined operation were selected, and the cortical electrode was used to detect the lesion and its periphery. Further confirm the scope of epileptogenic focus and surgical resection area. All cases of intraoperative cortical electrode monitoring epileptiform focus and its surrounding records abnormal discharge. While preserving the important cortical functional area of the patient. The lesions and / or epileptogenic foci were resected by microsurgery and monitored by electrocortical electroencephalogram (ECo G). Results 195 electrodes were implanted in 21 patients, with an average of 9.2 electrodes. Electrode indwelling intracranial 7 to 35 days, an average of 13 days; The clinical seizures were captured 2-5 times, with an average of 3 times. 20 patients were diagnosed as epileptic foci. Among them, 8 patients underwent resection of temporal pole, hippocampus and amygdala. One patient had left frontal cortex dysplasia resection and one patient had right temporal cortex dysplasia resection and occipital lobe amputation. One patient underwent resection of left parietal malacia and peripheral epileptic foci. The right superior frontal gyrus, partial cortex of middle frontal gyrus and frontal pole resection were performed in 1 case. Left medial occipital cortex resection was performed in 1 case. One patient had left frontal lobe cyst and partial anterior temporal lobectomy. One patient underwent subparietal lobectomy and partial temporal lobectomy. 1 case of resection of the middle and posterior part of inferior frontal gyrus; The right cingulate gyrus and posterior cingulate gyrus were resected and corpus callosum was cut. One patient underwent resection of the posterior part of the right middle frontal gyrus and part of the superior frontal gyrus. One patient received resection of the right superior edge of the gyrus and 1 patient refused the operation. 1 case did not have definite epileptic foci and adjusted the drug therapy. Complications: 1 case had intracranial hemorrhage, 1 case had no symptoms of neurological loss, 1 case had skin infection, no death, cerebrospinal fluid leakage and electrode breakage, etc. Among the 19 cases of postoperative follow-up, there were 14 cases with Engel grade I, 2 cases with grade 鈪，

本文編號(hào)：1400639