本文選題：256導(dǎo)聯(lián)高密度腦電源定位 + 難治性癲癇��； 參考：《復(fù)旦大學(xué)》2014年博士論文

【摘要】：頭皮腦電源定位(ESI)是一種利用頭皮腦電記錄到的癲癇樣放電定位顱內(nèi)電位分布的技術(shù)手段,在國外已有較多研究,但在國內(nèi)相關(guān)研究比較滯后。最近,具有高空間分辨率的256導(dǎo)聯(lián)高密度腦電源定位技術(shù)(256-ch dESI)在難治性癲癇術(shù)前評估領(lǐng)域已經(jīng)嶄露頭角,盡管國內(nèi)的相關(guān)研究尚屬空白,但國外已有一些相關(guān)的臨床研究,均在不同程度上證實(shí)了其應(yīng)用價(jià)值。相比現(xiàn)有的難治性癲癇術(shù)前無創(chuàng)評估手段如結(jié)構(gòu)相核磁共振(MRI)、正電子發(fā)射計(jì)算機(jī)斷層顯像(PET)、傳統(tǒng)頭皮腦電圖(cEEG)、發(fā)作癥狀學(xué)評估(semiology)、腦磁圖(MEG)等,256-ch dESI具備較多優(yōu)勢。它同時(shí)具備高時(shí)間和空間分辨率、無創(chuàng)性、無毒副作用等優(yōu)點(diǎn),且能夠進(jìn)行長程記錄,對被試者的配合能力要求不高,對深部致癇區(qū)的檢測亦很敏感,在難治性癲癇的無創(chuàng)術(shù)前評估領(lǐng)域大有應(yīng)用前景。本研究利用在本單位接受手術(shù)治療的難治性癲癇病例,通過科學(xué)手段探討了256-ch dESI對難治性癲癇的術(shù)前評估價(jià)值以及不同源定位結(jié)果(“源”,sources)模式(pattern)對預(yù)后的影響,并且通過基于個(gè)體解剖數(shù)據(jù)的高分辨率個(gè)體頭模以及影像融合手段探討了基于個(gè)體頭模的256導(dǎo)聯(lián)高密度腦電源定位(256-ch dESI IHM)技術(shù)在術(shù)前評估中的應(yīng)用及價(jià)值。本研究實(shí)現(xiàn)了國際、國內(nèi)范圍內(nèi)的多個(gè)創(chuàng)新。第一部分：256導(dǎo)聯(lián)高密度腦電源定位技術(shù)對難治性癲癇的術(shù)前評估價(jià)值研究本部分利用53例難治性癲癇病例探討了256-ch dESI的術(shù)前評估價(jià)值。所有病例均在我科接受包括256-ch dESI在內(nèi)的多種無創(chuàng)致癇區(qū)評估工具檢查,繼而接受Ⅰ期切除性手術(shù)治療。將預(yù)后良好患者的手術(shù)切除區(qū)域定義為致癇區(qū)范圍,以亞腦葉水平和腦葉水平兩種標(biāo)準(zhǔn)評價(jià)多種工具的定位價(jià)值。標(biāo)準(zhǔn)1(亞腦葉水平)：評估工具的定位結(jié)果位于切除范圍內(nèi)則定義為準(zhǔn)確,接受評價(jià)的工具包括256-ch dESI. PET和MRI；標(biāo)準(zhǔn)2(腦葉水平)：評估工具的定位結(jié)果與手術(shù)切除區(qū)域位于同一腦葉,則定義為準(zhǔn)確,接受評價(jià)的工具包括256-ch dESI, PET,MRI,發(fā)作癥狀學(xué)和cEEG。此外,我們根據(jù)MRI、發(fā)作癥狀學(xué)及cEEG結(jié)果篩選出14例明確診斷的顳葉內(nèi)側(cè)癲癇(mTLE),以顳葉底面及內(nèi)側(cè)結(jié)構(gòu)作為致癇區(qū)評估標(biāo)準(zhǔn),評價(jià)256-ch dESI和PET對mTLE的評估價(jià)值。本研究還利用統(tǒng)計(jì)學(xué)方法對源定位結(jié)果(“源”)模式等因素與預(yù)后的關(guān)系進(jìn)行了分析。結(jié)果顯示,無論采取哪種評價(jià)標(biāo)準(zhǔn),256-ch dESI均擁有最高的敏感度和特異度。在14例mTLE病例中,256-ch dESI提示的致癇區(qū)在78.6%的病例中完全位于顳葉內(nèi)側(cè)及底面,而PET僅有36.4%,提示256-ch dESI較PET能夠提供更加精確的定位信息(p0.05,Fisher精確檢驗(yàn))。根據(jù)源定位結(jié)果(“源”)為單一性或多灶性將53例病例分為“單源”和“多源”兩組：利用Kaplan-Meier生存分析,結(jié)果顯示“單源”組術(shù)后癲癇緩解的可能性顯著性優(yōu)于“多源”組(p0.05,Log Rank);根據(jù)“源”是否被切除將病例分為兩組：利用Kaplan-Meier生存分析,結(jié)果顯示“源”被切除組術(shù)后癲癇緩解的可能性較未被切除者更高(p0.05,Log Rank)。采用Cox回歸多因素分析方法,結(jié)果顯示“源”被切除與良好預(yù)后相關(guān)。256-ch dESI同時(shí)具備高空間和高時(shí)間分辨率,較其它傳統(tǒng)工具具有獨(dú)特的優(yōu)勢。增加的電極數(shù)量和面頰、頸等處的電極覆蓋使得其對顳葉內(nèi)側(cè)、底面等處的放電檢測更為敏感。關(guān)于源定位結(jié)果(“源”)模式的研究顯示“單源”病例可能較“多源”病例更適合接受Ⅰ期切除性手術(shù),且切除“源”可能與良好預(yù)后相關(guān),這同時(shí)也提示反復(fù)出現(xiàn)發(fā)作間期癲癇樣放電(IEDs)的區(qū)域(激惹區(qū))與致癇區(qū)有較好的關(guān)聯(lián)性；“多源”病例則可能需要考慮先進(jìn)行顱內(nèi)電極埋置手術(shù)以利用顱內(nèi)電極腦電圖(icEEG)明確致癇區(qū)范圍。發(fā)作期腦電因信噪比低等原因并不適合256-ch dESI,但我們的初步探索顯示該技術(shù)是可行的,值得進(jìn)一步開展相關(guān)研究。目前發(fā)作期腦電的獲取仍主要依賴cEEG。第二部分：PET陽性、MRI陰性顳葉癲癇的外科治療以及256導(dǎo)聯(lián)高密度腦電源定位技術(shù)對其術(shù)前評估價(jià)值的研究本中心的回顧性研究探討了PET陽性、MRI陰性顳葉癲癇(PET+MRI-TLE)的外科治療。從發(fā)作癥狀學(xué)、人口統(tǒng)計(jì)學(xué)、外科治療以及預(yù)后評估的角度,我們利用41例海馬硬化型顳葉癲癇(HS+TLE)和18例良性病灶性顳葉癲癇(L+TLE)對比分析了19例PET+MRI-TLE的臨床特點(diǎn)、外科治療及預(yù)后。數(shù)據(jù)分析顯示,PET+MRI-TLE組的預(yù)后(Engle Ⅰ級：68.4%,Engle Ⅰ+Ⅱ級：84.2%)與HS+TLE組(Engle Ⅰ級：68.3%,Engle Ⅰ+Ⅱ級：80.5%)沒有顯著差異(p0.05)。分析還顯示,PET+MRI-TLE組和HS+TLE組的熱性驚厥史比例和繼發(fā)強(qiáng)直陣攣發(fā)作比例有顯著差異(p0.05)。一定程度上,PET+MRI-TLE可能是異于HS+TLE的臨床疾病,而非HS+TLE的一種亞型�？偟膩碚f,經(jīng)正確評估和篩選的PET+MRI-TLE可以考慮接受Ⅰ期切除性手術(shù)。PET雖然是定位顳葉致癇區(qū)的有力工具,然而,它具有特異度低、定位范圍廣泛等缺點(diǎn)。256-ch dESI作為較新出現(xiàn)的無創(chuàng)定位工具,同時(shí)擁有高時(shí)間、空間分辨率,我們設(shè)計(jì)了相關(guān)研究將其應(yīng)用于PET+MRI-TLE的術(shù)前評估,探討了其定位價(jià)值。通過入選和排除標(biāo)準(zhǔn),我們選定了12例PET+MRI-TLE病例,利用手術(shù)切除區(qū)域結(jié)合預(yù)后來定義致癇區(qū)范圍,即在預(yù)后良好的病例中(9例),如某種工具的定位結(jié)果包含在切除區(qū)域以內(nèi)(標(biāo)準(zhǔn)1,亞腦葉水平)或與切除區(qū)域在同一腦葉(標(biāo)準(zhǔn)2,腦葉水平),則定義為準(zhǔn)確。采用標(biāo)準(zhǔn)1,256-ch dESI的定位準(zhǔn)確度為7/9=77.8%,2例“不準(zhǔn)確”者的結(jié)果為：源定位結(jié)果(“源”)位于中、后顳葉、顳枕交界區(qū)；PET的準(zhǔn)確度為7/9=77.8%,2例“不準(zhǔn)確”的結(jié)果為：低代謝范圍廣泛,累及后顳葉、顳枕交界區(qū)等處。采用標(biāo)準(zhǔn)2,定位于同側(cè)顳葉即定義為準(zhǔn)確,則256-ch dESI的準(zhǔn)確度提升至8/9=88.9%,1例“不準(zhǔn)確”的結(jié)果為：“源”位于顳枕交界區(qū)。PET則準(zhǔn)確定位所有病例,發(fā)作癥狀學(xué)評估的準(zhǔn)確度為3/9=33.3%,cEEG的準(zhǔn)確度為5/9=55.6%。根據(jù)“源”是否位于前顳葉進(jìn)行分組,結(jié)果顯示,具有前顳葉“源”病例的預(yù)后要顯著性優(yōu)于具有非前顳葉“源”的病例(100%VS 40%,p0.05,Fisher精確檢驗(yàn))。本研究在國際范圍內(nèi)第一次將256-ch dESI應(yīng)用于PET+MRI-TLE的術(shù)前評估并對其應(yīng)用價(jià)值做出探索,結(jié)果顯示,256-ch dESI是一種有前景的、可用于MRI陰性癲癇精確定位的方法。根據(jù)本研究結(jié)果,對于PET+MRI-TLE來說,如果256-ch dESI定位于前顳葉,則病例適合進(jìn)行Ⅰ期前顳葉切除手術(shù)；如果256-ch dESI定位于非前顳葉處如后顳葉或顳枕交界等部位,則需謹(jǐn)慎行Ⅰ期切除性手術(shù)。這個(gè)特點(diǎn)對于此類難治性癲癇病例的選擇有一定指導(dǎo)意義。發(fā)作期腦電數(shù)據(jù)并不適合進(jìn)行256-ch dESI,但依賴cEEG獲取的發(fā)作期腦電應(yīng)是MRI陰性癲癇術(shù)前評估的重要組成部分。對于MRI陰性癲癇,手術(shù)方案決不能盲目依據(jù)單一評估手段確定,而應(yīng)是綜合多種評估手段的結(jié)果,必要時(shí)需考慮進(jìn)行顱內(nèi)電極腦電圖(icEEG)檢查以明確致癇區(qū)所在。第三部分：基于高分辨率個(gè)體頭模的256導(dǎo)聯(lián)高密度腦電源定位技術(shù)及其與顱內(nèi)電極腦電圖的影像融合研究目前,關(guān)于高密度腦電源定位(dESI)研究的正演模型一般均基于公共頭模(AHM),另外有少數(shù)研究基于融入個(gè)體頭顱MRI的改良頭模(SMAC),但其本質(zhì)仍為球形頭模,只是將平均MRI影像替換為個(gè)體MRI影像。本研究結(jié)合臨床病例,利用多模態(tài)影像融合技術(shù),將基于高分辨率個(gè)體頭模的256導(dǎo)聯(lián)高密度腦電源定位技術(shù)(256-ch dESI IHM)應(yīng)用于難治性癲癇術(shù)前評估,并探討其在致癇區(qū)定位方面的理論與臨床應(yīng)用價(jià)值,屬國內(nèi)首次,國際領(lǐng)先。在獲取3D-SPGR序列MRI(從頭頂掃描至下頜)和256導(dǎo)聯(lián)高密度腦電數(shù)據(jù)后,通過計(jì)算機(jī)及手工處理得到256-ch dESI IHM結(jié)果。接受顱內(nèi)電極埋置手術(shù)的病例在術(shù)后次日獲取全腦薄層CT平掃,繼而通過計(jì)算機(jī)與手工處理與個(gè)體頭模融合。本研究通過兩種標(biāo)準(zhǔn)評價(jià)致癇區(qū)定位工具。標(biāo)準(zhǔn)1：將預(yù)后良好病例的手術(shù)切除區(qū)域定義為致癇區(qū)范圍,若某工具所定義的致癇區(qū)在此切除范圍以內(nèi),則為準(zhǔn)確；標(biāo)準(zhǔn)2：以顱內(nèi)電極腦電圖(icEEG)為致癇區(qū)定位標(biāo)準(zhǔn),若某工具所定義的致癇區(qū)與icEEG吻合,則定義為準(zhǔn)確。接受icEEG檢查的病例接受此標(biāo)準(zhǔn)評價(jià)。7例患者接受標(biāo)準(zhǔn)1評價(jià),準(zhǔn)確度如下：256-ch dESI IHM 7/7=100%,基于公共頭模的256-ch dESI (256-ch dESI AHM) 6/7=85.7%, PET 3/7=42.9%和MRI 5/7=71.4%。僅256-ch dESI IHM準(zhǔn)確定位所有病例的致癇區(qū)。4例PET結(jié)果“不準(zhǔn)確”均因其顯示的低代謝范圍較為廣泛。2例MRI結(jié)果“不準(zhǔn)確”均因其缺乏有意義的局灶性病變。1例“不準(zhǔn)確”的256-ch dESI AHM結(jié)果位于切除區(qū)域附近。采用標(biāo)準(zhǔn)2即以icEEG為標(biāo)準(zhǔn)對病例1進(jìn)行評價(jià),256-ch dESI IHM與icEEG高度吻合,而256-ch dESI AHM, PET和MRI均出現(xiàn)不吻合處。256-ch dESI AHM雖然精準(zhǔn)度稍欠缺,但其能夠方便快捷的融入難治性癲癇的無創(chuàng)綜合評估流程,是傳統(tǒng)工具的有益補(bǔ)充。利用個(gè)體MRI重建顱腦幾何形態(tài)、根據(jù)真實(shí)皮層方向分布有向偶極子、設(shè)定各組織合理的電傳導(dǎo)率并獲取高密度腦電數(shù)據(jù)后,高精準(zhǔn)度的256-ch dESI IHM技術(shù)已具備可行性,并且它可以將包括icEEG在內(nèi)的多種評估工具的結(jié)果融合在同一視圖,有利于更精確的制定術(shù)前規(guī)劃及手術(shù)方案。本研究率先將256-ch dESI IHM技術(shù)應(yīng)用于難治性癲癇術(shù)前評估,并開展了256-ch dESI IHM與“金標(biāo)準(zhǔn)”icEEG的影像融合研究,驗(yàn)證了256-ch dESI IHM的精準(zhǔn)度,證實(shí)了它的應(yīng)用前景。我們再次證實(shí)經(jīng)準(zhǔn)確識(shí)別的、反復(fù)出現(xiàn)的IEDs的產(chǎn)生區(qū)(激惹區(qū))與致癇區(qū)有很好的關(guān)聯(lián)性。但激惹區(qū)與其余分區(qū)如癥狀產(chǎn)生區(qū),發(fā)作起始區(qū),致癇病灶和功能缺失區(qū)都只能在一定程度上代表了致癇區(qū)的范圍,任何一種分區(qū)都不能完全等同于致癇區(qū)。因此,外科手術(shù)方案必須是綜合了多種定位方法的結(jié)果。256-ch dESI AHM/IHM不能夠取代其它工具(尤其是目前256-ch dESI技術(shù)主要基于發(fā)作間期癲癇樣放電,而發(fā)作期腦電的獲取在大部分情況下仍需依賴cEEG甚至icEEG),但該技術(shù)的優(yōu)勢和對致癇區(qū)定位的指導(dǎo)意義是不容忽視的。屬性不符
[Abstract]:Scalp brain power location (ESI) is a technical means to locate the distribution of intracranial potential using the epileptiform discharge from the scalp electroencephalogram (EEG). There have been many studies abroad, but the related research in China is lagging behind. Recently, the high spatial resolution 256 lead high-density brain location technique (256-ch dESI) has been used to evaluate the treatment of intractable epilepsy. The field of estimation has come to the fore. Although domestic related studies are still blank, some related clinical studies abroad have proved its application in varying degrees. Compared with existing non invasive methods such as structural phase nuclear magnetic resonance (MRI), positron emission computed tomography (PET), traditional scalp brain Electrogram (cEEG), paroxysmal symptom assessment (semiology), magnetoencephalogram (MEG), and so on, 256-ch dESI have many advantages. It has the advantages of high time and spatial resolution, noninvasive, non-toxic side effects, and can carry out long range records, the ability to cooperate with the subjects is not high, the detection of the deep epilepsy area is also very sensitive, in the refractory epilepsy. The field of noninvasive preoperative assessment is promising. This study explored the preoperative evaluation value of 256-ch dESI for intractable epilepsy and the effect of different source localization results ("source", sources) model (pattern) on the prognosis of intractable epilepsy in this unit by means of scientific means. The high resolution individual head model and image fusion method of the anatomic data are used to discuss the application and value of the 256 lead high density brain power location (256-ch dESI IHM) technology based on the individual head mode in the preoperative assessment. This study has achieved international and domestic innovation. Part one: the 256 lead high density brain power location technology Preoperative assessment value of refractory epilepsy study in this part of 53 cases of intractable epilepsy to explore the value of preoperative assessment of 256-ch dESI. All cases were examined in our department for a variety of non invasive zone assessment tools including 256-ch dESI, and then accepted stage I resection hand surgery. The region is defined as the area of the epileptic zone, evaluating the location value of a variety of tools with two criteria of Subcerebral lobe level and lobar level. Standard 1 (sublobar level): the assessment tool's positioning results are defined within the range of excision, and the tools for evaluation include 256-ch dESI. PET and MRI; standard 2 (lobe level): assessment tool's determination 256-ch dESI, PET, MRI, paroxysmal symptoms, and cEEG. were defined as the accuracy of the position and the surgical area in the same lobes. We screened 14 clearly diagnosed medial temporal epilepsy (mTLE) based on MRI, paroxysmal symptoms and cEEG results. The temporal lobe and medial structure were used as the assessment of the epileptic zone. Evaluate the value of 256-ch dESI and PET for the assessment of mTLE. This study also analyzed the relationship between factors such as source localization results ("source") patterns and prognosis using statistical methods. The results showed that 256-ch dESI had the highest sensitivity and specificity regardless of which criteria were taken. In 14 cases of mTLE, 256-ch dESI was suggested. The eclampsia area was completely located in the medial and bottom of the temporal lobe in 78.6% of the cases, while PET was only 36.4%, suggesting that 256-ch dESI could provide more accurate positioning information (P0.05, Fisher accurate test). 53 cases were divided into "single source" and "multi source" two groups according to the source localization results ("source"), which were divided into "single source" and "multi source" groups: using Kaplan-Meie. R survival analysis showed that the possibility of postoperative epilepsy remission in the "single source" group was significantly better than that of the "multisource" group (P0.05, Log Rank). According to whether the "source" was removed, the cases were divided into two groups: using Kaplan-Meier survival analysis, the results showed that the possibility of epileptic remission in the "source" group was higher than that of the non resected group (P0.05, Lo). G Rank). Using the Cox regression multifactor analysis, the results showed that the source was excised and the good prognosis related to.256-ch dESI had high spatial and high temporal resolution. It had a unique advantage over other traditional tools. The number of electrodes increased and the electrode cover at the cheek and neck made it detect the discharge of the inside and bottom of the temporal lobe. The study of the source location results ("source") model showed that the single source case may be more suitable for a stage I resection than the "multisource" case, and the removal of "source" may be associated with good prognosis, which also suggests that the region (irritable area) that repeated episodes of interictal epileptic discharge (IEDs) is more than that in the epileptic zone. Good correlation; "multi source" cases may need to consider intracranial electrode embedding first to make use of the intracranial electrode electroencephalogram (icEEG) to clear the area of epilepsy. 256-ch dESI is not suitable for the onset of EEG due to low signal to noise ratio, but our preliminary exploration shows that the technique is feasible and worthy of further research. Current seizures of EEG still depend mainly on cEEG. second parts: PET positive, surgical treatment of MRI negative temporal lobe epilepsy and the value of 256 lead high-density brain power location technology for its preoperative evaluation. The retrospective study of the center is a retrospective study on PET positive, MRI negative temporal lobe epilepsy (PET+MRI-TLE) surgery. The clinical characteristics, surgical treatment and prognosis of 19 cases of PET+MRI-TLE were compared and analyzed in 41 cases of hippocampal sclerosis type temporal lobe epilepsy (HS+TLE) and 18 cases of benign temporal lobe epilepsy (L+TLE). The data analysis showed that the prognosis of group PET+MRI-TLE (Engle grade I: 68.4%, Engle I). + class II: 84.2%) there was no significant difference from group HS+TLE (Engle I: 68.3%, Engle I + II: 80.5%). The analysis also showed that the proportion of thermal convulsions in PET+MRI-TLE and HS+TLE groups was significantly different from that of secondary tonic clonic seizures (P0.05). To a certain extent, PET+MRI-TLE may be a clinical disease that is different from HS+TLE, not HS+TLE. In general, the PET+MRI-TLE, which is correctly evaluated and screened, can consider the acceptance of stage I excision operation.PET, although it is a powerful tool for locating the temporal lobe epilepsy area, however, it has the disadvantages of low specificity and wide range of location, such as.256-ch dESI as a newer non-invasive positioning tool, with high time and spatial resolution. Rate, we have designed a related study to apply it to the preoperative assessment of PET+MRI-TLE and explore its positioning value. Through the selection and exclusion criteria, we selected 12 cases of PET+MRI-TLE, using the surgical excision area combined with the pre definition of the area of the epileptic zone, that is, in the well prognosis cases (9 cases), such as the positioning results of some kind of tool. In the excision area (standard 1, sublobular level) or in the same lobes (standard 2, lobar level), the accuracy was defined. The accuracy of the standard 1256-ch dESI was 7/9=77.8%, and the result of 2 cases of "inaccurate" was that the source location ("source") was located in the middle, posterior temporal lobe, and the temporal occipital junction; the accuracy of PET was 7/9 =77.8%, 2 cases of "inaccurate" results were: a wide range of low metabolism, involving the posterior temporal lobe and the temporal occipital junction. Using standard 2, located in the ipsilateral temporal lobe was defined as accurate, the accuracy of 256-ch dESI was raised to 8/9=88.9%, and 1 cases of "inaccurate" results were that the "source" located in the temporal occipital junction.PET accurately locates all cases, hair The accuracy of the symptomatic assessment was 3/9=33.3%, and the accuracy of the cEEG was 5/9=55.6%. based on whether the source was located in the anterior temporal lobe. The results showed that the prognosis of the "source" case with the anterior temporal lobe was significantly better than that of the non anterior temporal lobe (100%VS 40%, P0.05, Fisher accurate test). This study was the first in the world. 256-ch dESI is applied to the preoperative assessment of PET+MRI-TLE and its application value. The results show that 256-ch dESI is a promising method for accurate localization of MRI negative epilepsy. According to the results of this study, if 256-ch dESI is located in the anterior temporal lobe, the case is suitable for the first phase of the anterior temporal lobe. Except for the operation, if 256-ch dESI is located in the non anterior temporal lobe, such as the posterior temporal lobe or the temporal occipital junction, we should be careful with the stage I excision operation. This characteristic is of certain guiding significance for the selection of such cases of intractable epilepsy. The seizure period EEG data is not suitable for 256-ch dESI, but the seizure period of EEG dependent on cEEG should be MR The important component of preoperative assessment of I negative epilepsy. For MRI negative epilepsy, the operation scheme must not be determined blindly according to a single evaluation method, but should be the result of a comprehensive variety of evaluation methods. The intracranial electrode electroencephalogram (icEEG) examination should be considered when necessary. The third part: Based on the high resolution individual head model. The 256 lead high-density brain power source localization technology and the image fusion with the intracranial electrode electroencephalogram (EEG), the forward model of the high density brain power location (dESI) research is generally based on the common head model (AHM), and a few studies are based on the modified head die (SMAC) based on the individual head MRI, but the essence is still spherical head model, only The average MRI image was replaced by an individual MRI image. Combined with clinical cases, the 256 lead high-density brain power location technique (256-ch dESI IHM) based on high resolution individual head model was applied to the preoperative assessment of intractable epilepsy combined with clinical cases, and the theoretical and clinical value of its application in the localization of epileptogenic area was discussed. Value, international lead. After obtaining the 3D-SPGR sequence MRI (from the head scan to the mandible) and the 256 lead high-density EEG data, the results of 256-ch dESI IHM are obtained by computer and manual processing. The case of intracranial electrode embedding surgery is obtained on the next day after the operation, and then the whole brain thin layer CT plain scan is obtained, and then the computer and manual processing and manual processing are carried out. Individual head model fusion. The present study evaluated the epileptic zone positioning tools by two criteria. Standard 1: the surgical area of a good prognosis case was defined as the area of the epileptogenic area. If a tool defined the eclampsia area within this area, it was accurate; standard 2: intracranial electrode electroencephalogram (icEEG) as the location standard for epileptogenic area, if a worker The defined epileptic zone was consistent with icEEG and was defined as accurate. The case accepted by icEEG was evaluated by the standard 1, and the accuracy was as follows: 256-ch dESI IHM 7/7=100%, 256-ch dESI (256-ch dESI AHM) based on the common head model. .4 PET results in the eclampsia area of all cases were "inaccurate" because of their low metabolic range of.2 MRI results "inaccurate" because of their lack of meaningful focal lesions,.1 cases of "inaccurate" 256-ch dESI AHM results were located near the excision area. Standard 2 was used to evaluate case 1 with icEEG as the standard, 25 6-CH dESI IHM and icEEG are highly consistent with icEEG, while 256-ch dESI AHM, PET and MRI all do not coincide with.256-ch dESI AHM, although the accuracy is slightly deficient, but it is a useful supplement to traditional tools. 256-ch dESI IHM technology with high precision has been feasible after setting a dipole, setting reasonable transmission rate and obtaining high density EEG data, and it can integrate the results of a variety of assessment tools including icEEG to the same view, which helps to make the pre operation planning and operation plan more accurate. First, 256-ch dESI IHM technology was applied to the preoperative assessment of intractable epilepsy, and the image fusion of 256-ch dESI IHM and "gold standard" icEEG was carried out. The accuracy of 256-ch dESI IHM was verified and its application prospects were confirmed. Good correlation. However, the irritable zone and the other regions, such as symptom producing areas, seizure initiation area, epileptogenic focus and functional deletion area, can only be one.

【學(xué)位授予單位】：復(fù)旦大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2014
【分類號】：R742.1

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