本文關(guān)鍵詞： 島葉 癲癇 立體定向腦電圖 顱內(nèi)電極 皮層電刺激　出處：《山西醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:島葉被稱為第五腦葉,解剖位置隱蔽,參與的功能和網(wǎng)絡(luò)復(fù)雜,涉及島葉的癲癇病人癥狀學(xué)表現(xiàn)多樣化,國(guó)內(nèi)外至今為止有多種方法研究其結(jié)構(gòu)、功能和網(wǎng)絡(luò)。本文通過(guò)回顧性分析40例癲癇患者SEEG皮層電刺激資料來(lái)研究島葉的功能和解剖,探討各島回在癲癇癥狀產(chǎn)生或相關(guān)致癇網(wǎng)絡(luò)中的作用。方法:回顧性分析2014.4~2016.5在清華大學(xué)玉泉醫(yī)院癲癇中心行了立體定向腦深部電極置入術(shù),篩選出在島葉置入電極的40例病人皮層電刺激資料。將病人置入電極后的頭顱CT與術(shù)前MRI圖像進(jìn)行配準(zhǔn)融合并三維重建MRI結(jié)構(gòu)像,對(duì)每個(gè)電極觸點(diǎn)進(jìn)行精確定位。在相鄰電極觸點(diǎn)進(jìn)行雙相方波刺激,刺激參數(shù)為頻率50Hz,波寬0.3ms,刺激強(qiáng)度0.2-3mA,時(shí)間為5s。進(jìn)一步對(duì)皮層電刺激結(jié)果按性質(zhì)和部位歸類。結(jié)果:40例病人中,位于島葉的電極觸點(diǎn)數(shù)為220個(gè),電刺激有反應(yīng)數(shù)為106個(gè),反應(yīng)率為48.2%。將電刺激反應(yīng)的癥狀(除外發(fā)作先兆和后放電)按性質(zhì)分為軀體感覺(jué)、聽(tīng)幻覺(jué)、疼痛覺(jué)、植物神經(jīng)癥狀、味覺(jué)、口咽部癥狀及其它。軀體感覺(jué)主要見(jiàn)于島中央后回,聽(tīng)幻覺(jué)常見(jiàn)于后長(zhǎng)回和島中央后回的后緣,疼痛覺(jué)分布較分散,植物神經(jīng)癥狀主要見(jiàn)于島極,口咽部癥狀只見(jiàn)于島中央前回。結(jié)論:通過(guò)對(duì)置入島葉的顱內(nèi)深部電極皮層電刺激產(chǎn)生的癥狀及分布的特征的分析,有助于對(duì)島葉的解剖及功能的理解,有助于評(píng)價(jià)各個(gè)島回在癲癇癥狀產(chǎn)生或相關(guān)致癇網(wǎng)絡(luò)中的作用。同時(shí)也說(shuō)明立體定向腦深部電極置入在懷疑涉及島葉的癲癇病人評(píng)估中的重要作用。
[Abstract]:Objective: the insular lobe is known as the 5th lobes of the brain. Its anatomical location is concealed, its function and network are complex, the symptomatic manifestations of epileptic patients involved in the insular lobe are diversified, and there are many methods to study its structure at home and abroad. Function and network. The function and anatomy of the insular lobe were studied by retrospectively analyzing the data of SEEG electrical stimulation in 40 patients with epilepsy. Objective: to explore the role of the gyrus of each island in the epileptic symptom generation or associated epileptic network. Methods: stereotactic deep brain electrode implantation was performed in the epileptic center of Yuquan Hospital, Tsinghua University, on June 6, 2014. Cortical electrical stimulation data were selected from 40 patients who were implanted with electrodes in the insular lobe. The CT images were registered with preoperative MRI images, and 3D MRI images were reconstructed. Accurate location of each electrode contact. Biphasic square wave stimulation at adjacent electrode contact, The stimulation parameters were frequency 50 Hz, wave width 0.3 Ms, stimulation intensity 0.2-3 Ma, time 5 s. Further, the results of cortical electrical stimulation were classified according to their properties and locations. Results in 40 patients, the number of electrode contacts located in the insular lobe was 220, and the number of responsive electrical stimuli was 106. The response rate was 48.2%. The symptoms of electrical stimulation (excluding onset precursor and post-discharge) were divided into somatosensory, auditory hallucination, pain sensation, autonomic nerve symptom, taste sensation, oropharyngeal symptom and others according to their properties. Somatosensory symptoms were mainly found in the posterior central gyrus of the island. Auditory hallucinations were common in the posterior margin of the posterior long gyrus and the posterior central gyrus of the island. Conclusion: it is helpful to understand the anatomy and function of the island by analyzing the characteristics of the symptoms and distribution of the electrical stimulation of the deep intracranial electrode in the precentral part of the island. It is helpful to evaluate the role of each island gyrus in the generation of epilepsy symptoms or associated epileptic network. It also shows the important role of stereotactic deep brain electrode placement in the evaluation of epileptic patients suspected to be involved in the insular lobe.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R651.1

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