本文選題：皮層腦電圖 + 繼發(fā)性癲癇��； 參考：《蘭州大學(xué)》2014年碩士論文

【摘要】：目的：探討皮層腦電圖監(jiān)測(cè)下繼發(fā)性癲癇的外科治療方法及療效。 方法：對(duì)40例繼發(fā)性癲癇患者術(shù)前行常規(guī)腦電圖、長(zhǎng)程視頻腦電圖檢查,并聯(lián)合CT.MRI或者fMRI.MRS等影像學(xué)檢查結(jié)果及臨床表現(xiàn)綜合分析,初步確定致癇灶的部位及范圍。術(shù)中通過皮層腦電圖定位致癇灶,顯微手術(shù)切除原發(fā)病灶后,再根據(jù)皮層腦電監(jiān)測(cè)結(jié)果、癲癇發(fā)作的臨床表現(xiàn)、病灶部位決定進(jìn)行致癇灶切除、皮層熱灼、多處軟膜下橫纖維切斷、前顳葉切除、杏仁核海馬切除及胼胝體前部切開術(shù)等；術(shù)后常規(guī)應(yīng)用抗癲癇藥物并隨訪。 結(jié)果：40例患者術(shù)前頭皮腦電圖檢查,其中33例顯示癲癇波放電部位與影像學(xué)病變部位符合或相近,6例顯示廣泛癇性放電,1例未發(fā)現(xiàn)癲癇波。切除病灶前均通過皮層腦電圖監(jiān)測(cè)到癲癇波,切除原發(fā)病變后再次皮層腦電圖監(jiān)測(cè)病變周圍皮質(zhì)可記錄到異常致癇波28例,占70%。其中22例位于重要功能區(qū)或與之相近,采用皮層熱灼或軟膜下橫切后,20例癲癇波消失,剩余2例患者行選擇性海馬-杏仁核切除和胼胝體前部切開,皮層腦電圖監(jiān)測(cè)示癇性波顯著減少；另有6例位于非功能區(qū),切除癇性放電區(qū)域的皮質(zhì),再行皮層腦電圖監(jiān)測(cè)癇性波消失,手術(shù)效果滿意。術(shù)后隨訪3-18個(gè)月,根據(jù)Engel標(biāo)準(zhǔn)評(píng)判療效,EngelⅠ級(jí)：29例(72.5%)；Ⅱ級(jí)：7例(17.5%)；Ⅲ級(jí)：3例(7.5%)；Ⅳ級(jí)：1例(2.5%)�？傆行д�39例,有效率為97.5%。 結(jié)論：在完全切除原發(fā)病灶后,術(shù)中運(yùn)用皮層腦電圖監(jiān)測(cè),可以定位原發(fā)病灶以外的致癇灶及重要功能區(qū),指導(dǎo)手術(shù)中準(zhǔn)確切除致癇灶最大限度保留神經(jīng)功能,預(yù)測(cè)手術(shù)療效,明顯提高手術(shù)治療的有效性。
[Abstract]:Objective: to investigate the surgical treatment and curative effect of secondary epilepsy under cortical electroencephalogram monitoring. Methods: 40 patients with secondary epilepsy were examined by routine EEG and long range video EEG before operation, and combined with CT. MRI or fMRI.MRS, the location and range of epileptogenic foci were preliminarily determined. The epileptogenic foci were located by electrocortical electroencephalogram (EEG) during the operation. After the primary lesions were resected by microsurgery, according to the results of cortical EEG monitoring, the location of epileptic seizures was determined by resection of epileptogenic foci and cauterization of cortical heat. Multiple subpial transection, anterior temporal lobectomy, hippocampal resection of amygdaloid nucleus and anterior corpus callosum were performed, and antiepileptic drugs were routinely used and followed up. Results electroencephalogram of scalp was examined in 40 patients before operation, of which 33 cases showed epileptic wave discharge site in accordance with or similar to imaging lesion location. 6 cases showed extensive epileptic discharge in 1 case and no epileptic wave was found in 1 case. Epileptic waves were detected by cortical electroencephalogram (EEG) before excision, and abnormal epileptic waves were recorded in 28 cases (70%) by cortical electroencephalogram (EEG) monitoring again after resection of primary lesions. Among them, 22 cases were located in or close to the important functional area, 20 cases of epileptic wave disappeared after cortical cauterization or subpial transection, the remaining 2 cases underwent selective hippocampal amygdaloidectomy and anterior callosum incision. Electrocortical electroencephalogram (EEG) was used to monitor the disappearance of epileptic wave, and 6 cases were located in the non-functional area, the cortex was excised from the epileptic discharge area, and the operative effect was satisfactory. The follow-up period was 3-18 months. According to the Engel criterion, 29 cases of Engel 鈪，

本文編號(hào)：2047419