[1]陈芳卿　徐宏浩　朱海涛等.SEEG引导下手术治疗药物难治性癫痫的安全性及有效性[J].中国临床神经外科杂志,2021,26(10):751-754.[doi:10.13798/j.issn.1009-153X.2021.10.003]
　CHEN Fang-qing,XU Hong-hao,ZHU Hai-tao,et al.Safety and effectiveness of SEEG-guided surgery for patients with drug-resistant epilepsy[J].,2021,26(10):751-754.[doi:10.13798/j.issn.1009-153X.2021.10.003]
点击复制

SEEG引导下手术治疗药物难治性癫痫的安全性及有效性()
分享到：

《中国临床神经外科杂志》[ISSN:1009-153X/CN:42-1603/TN]

卷:
26
期数:
2021年10期
页码:
751-754
栏目:
论著
出版日期:
2021-10-25

文章信息/Info

Title:
Safety and effectiveness of SEEG-guided surgery for patients with drug-resistant epilepsy
文章编号:
1009-153X（2021）10-0751-04
作者:
陈芳卿　徐宏浩　朱海涛等
作者单位：210029 南京，南京医科大学附属脑科医院功能神经外科（陈芳卿、徐宏浩、朱海涛、杨　露、张　焱、张　锐）
Author(s):
CHEN Fang-qing;  XU Hong-hao;  ZHU Hai-tao;  et al
Department of Functional Neurosurgery, The Brain Hospital Affiliated to Nanjing Medical University, Nanjing 210029, China
关键词:
药物难治性癫痫; 立体定向脑电图; 射频热凝损毁术; 致痫灶切除术
Keywords:
Drug-resistant epilepsy;  Stereoelectroencephalography;  Radiofrequency thermocoagulation;  Epileptic zones
分类号:
A
DOI:
10.13798/j.issn.1009-153X.2021.10.003
文献标志码:
R 742.1; R 651.1+1
摘要:
目的 探讨立体定向脑电图（SEEG）引导下手术治疗药物难治性癫痫（DRE）的安全性及有效性。方法 回顾性分析2018年8月至2020年8月SEEG引导下手术治疗的34例DRE的临床资料。SEEG引导下射频热凝损毁术（RF-TC）治疗28例，RF-TC无效而行致痫区切除术11例，SEEG引导下行致痫区切除术6例。34例术后随访14.0~39.3个月，平均（25.2±7.9）个月。结果 28例在SEEG引导下进行RF-TC，术中未出现不适，术后未出现颅内出血，术后4例出现功能障碍；单纯行SEEG引导下RF-TC治疗17例中，癫痫发作完全缓解11例，有效3例，无效3例。11例RF-TC后行致痫区切除术后，3例出现功能障碍，1例出现过敏性休克；术后8例无癫痫发作，2例调整药物后未再出现癫痫发作，1例术后癫痫发作减少60%~70%。6例SEEG引导下直接行致痫区切除术，术后出现功能障碍2例；术后5例无癫痫发作，1例调整抗癫痫药物后未再出现癫痫发作。结论 SEEG引导下RTFC治疗DRE是一种相对安全、有效的方法；致痫区广泛或RF-TC无效的DRE病人，可在SEEG引导下行致痫区切除术。
Abstract:
Objective To investigate the safety and efficacy of stereoelectroencephalography (SEEG)-guided surgery for the patients with drug-resistant epilepsy (DRE). Methods The clinical data of 34 patients with DRE who underwent SEEG-guided surgery from August 2018 to August 2020 were analyzed retrospectively. Of 34 patients, 28 received SEEG-guided radiofrequency thermocoagulation (RF-TC), 11 received epileptic zones resection (EZR) due to no effectiveness of RT-FC, and 6 received SEEG-guied EZR. The follow up ranged from 14.0 months to 39.3 months, with an average time of (25.2±7.9) moths. Results Of 28 patients undergoing RF-TC, no discomfort occurred during the operation and no intracranial hemorrhage occurred after the operation, and dysfunction occurred in 4 patients after the operation. Of 17 patients unergoing simple SEEG-guided RF-TC, 11 patients had complete seizure relief, 3 were effective and 3 were invalid. Of 11 patients undergoing EZR after RF-TC, 1 patient suffered from anaphylactic shock during the operation and 3 patients suffered from neurological dysfunction after the operation; 8 patients had no epileptic seizures after the operation, 2 had no seizures after drug adjustment, and 1 had 60%~70% reduction of postoperative seizures. Of 6 patients undergoing simple SEEG-guided EZR, 2 patients suffered from neurological dysfunction after the operation; 5 patients had no seizures and 1 had no seizures after drug adjustment. Conclusions SEEG-guided RT-FC is a relatively safe and effective method for the treatment of DRE. For DRE patients with extensive epileptic zones or no effectiveness of RF-TC, SEEG-guided EZR is a good choice.

参考文献/References:

[1] 中国抗癫痫协会. 临床诊疗指南-癫痫病分册（2015修订版）[M]. 第2版. 北京：人民卫生出版社，2015. 72.
[2] Manford M. Recent advances in epilepsy [J]. J Neurol, 2017,264(8): 1811-1824.
[3] Ryvlin P, Cross JH, Rheims S. Epilepsy surgery in children and adults [J]. Lancet Neurol, 2014, 13(11): 1114-1126.
[4] 罗　磊，朱海涛，徐宏浩，等. 脑磁图累积源成像在药物难治性颞叶癫痫术前评估中的应用[J]. 中国临床神经外科杂志，2021，26（2）：72-76.
[5] 廖白军，刘立红，石先俊，等. 额叶癫痫脑电模式分析[J].中国临床神经外科杂志，2021，26（2）：88-91.
[6] Isnard J, Taussig D, Bartolomei F, et al. French guidelines on stereoelectroencephalography (SEEG)[J]. Neurophysiol Clin, 2018, 48(1): 5-13.
[7] 柯燕燕，张春青，石先俊，等. 影像导航下立体定向脑电监测在额叶癫痫中的应用[J]. 中国临床神经外科杂志，2019，24（9）：513-515.
[8] Jutila L, Aikia M, Immonen A, et al. Long-term memory performance after surgical treatment of unilateral temporal lobe epilepsy (TLE) [J]. Epilepsy Res, 2014, 108(7): 1228-1237.
[9] 中国医师协会神经外科分会功能神经外科学组，中国抗癫痫协会，国家神经外科手术机器人应用示范项目专家指导委员会. 立体定向脑电图引导射频热凝毁损治疗药物难治性癫痫的中国专家共识[J]. 中华医学杂志，2021，101（29）：2276-2282.
[10] Catenoix H, Bourdillon P, Guénot M, et al. The combination of stereo-EEG and radiofrequency ablation [J]. Epilepsy Res, 2018, 142: 117-120.
[11] Chipaux M, Taussig D, Dorfmuller G, et al. SEEG-guided radiofrequency thermocoagulation of epileptic foci in the paediatric population: feasibility, safety and efficacy [J]. Seizure (London, England), 2019,70: 63-70.
[12] Bourdillon P, Cucherat M, Isnard J, et al. Stereo-electro-encephalography-guided radiofrequency thermocoagulation in patients with focal epilepsy: a systematic review and meta-analysis [J]. Epilepsia, 2018, 59(12): 2296-2304.
[13] Lee C, Li H, Wu T, et al. Efficacy of limited hippocampal radiofrequency thermocoagulation for mesial temporal lobe epilepsy [J]. J Neurosurg, 2019, 131(3): 781-789.
[14] Gao R, Yu T, Xu C, et al. The value of magnetoencephalo-graphy for stereo-EEG-guided radiofrequency thermoco-agulation in MRI-negative epilepsy [J]. Epilepsy Res, 2020,163: 106322.
[15] Moles A, Guénot M, Rheims S, et al. SEEG-guided radio-frequency coagulation (SEEG-guided RF-TC) versus anterior temporal lobectomy (ATL) in temporal lobe epilepsy[J]. J Neurol, 2018, 265(9): 1998-2004.
[16] Bourdillon P, Isnard J, Catenoix H, et al. Stereoelectroence-phalography-guided radiofrequency thermocoagulation (SEEG-guided RF-TC) in drug-resistant focal epilepsy: results from a 10-year experience [J]. Epilepsia (Copenhagen), 2017, 58(1): 85-93.
[17] Cossu M, Fuschillo D, Casaceli G, et al. Stereoelectroence-phalography-guided radiofrequency thermocoagulation in the epileptogenic zone: a retrospective study on 89 cases [J].J Neurosurg, 2015, 123(6): 1358.
[18] Malikova H, Vojtech Z, Liscak R, et al. Stereotactic radio-frequency amygdalohippocampectomy for the treatment of mesial temporal lobe epilepsy: Correlation of MRI with clinical seizure outcome [J]. Epilepsy Res, 2009, 83(2-3):235-242.
[19] Liscak R, Malikova H, Kalina M, et al. Stereotactic radio-frequency amygdalohippocampectomy in the treatment of mesial temporal lobe epilepsy [J]. Acta Neurochir (Wien), 2010, 152(8): 1291-1298.
[20] Wellmer J, Kopitzki K, Voges J. Lesion focused stereotactic thermo-coagulation of focal cortical dysplasia IIB: a new approach to epilepsy surgery [J]. Seizure (London, England),2014, 23(6): 475-478.

相似文献/References:

[1]郑　玺　顿晓熠.迷走神经刺激术对药物难治性癫痫患者认知功能的影响及其相关因素分析[J].中国临床神经外科杂志,2017,(03):142.[doi:10.13798/j.issn.1009-153X.2017.03.005]
　ZHENG Xi,DUN Xiao-yi..Observation of cognitive function and analysis of factors related to it in patients with intractable epilepsy after treatment by vagus nerve stimulation[J].,2017,(10):142.[doi:10.13798/j.issn.1009-153X.2017.03.005]
[2]张王成 综述　黄书岚 审校.成人难治性部分发作性癫痫的药物治疗研究进展[J].中国临床神经外科杂志,2017,(03):197.[doi:10.13798/j.issn.1009-153X.2017.03.028]
[3]杜秀玉 综述　栾国明 审校.大脑半球切除术后脑可塑性的研究进展[J].中国临床神经外科杂志,2017,(06):391.[doi:10.13798/j.issn.1009-153X.2017.06.008]
[4]崔德秋,单永治,赵国光,等.立体定向脑电图引导下射频毁损术治疗下丘脑错构瘤：1例报道并文献复习[J].中国临床神经外科杂志,2017,(07):497.[doi:10.13798/j.issn.1009-153X.2017.07.018]
[5]陈俊喜　郭　强　谭红平　王艮波　华　刚.ROSA引导下立体定向脑电图在儿童难治性癫痫手术中作用[J].中国临床神经外科杂志,2017,(09):623.[doi:10.13798/j.issn.1009-153X.2017.09.005]
　CHEN Jun-xi,GUO Qiang,TAN Hong-ping,et al.Application of ROSA-guided stereoelectroencephalography surgery for intractable epilepsy in children[J].,2017,(10):623.[doi:10.13798/j.issn.1009-153X.2017.09.005]
[6]王逸鹤　赵国光　单永治　樊晓彤　安　阳　卢　超.局灶性皮质发育不良致药物难治性癫痫的手术预后及其影响因素[J].中国临床神经外科杂志,2017,(11):737.[doi:10.13798/j.issn.1009-153X.2017.11.001]
　WANG Yi-he ZHAO Guo-guang,SHAN Yong-zhi,FAN Xiao-tong,et al.Analysis of factors related to postoperative prognoses in focal cortical dysplasia patients with refractory epilepsy[J].,2017,(10):737.[doi:10.13798/j.issn.1009-153X.2017.11.001]
[7]徐德辉　谢海涛　伍犹梁　谢学敏　余佳彬　张晓静　隋立森　赵　敏.脑灰质异位合并巨脑回及海马硬化致药物难治性癫痫1例[J].中国临床神经外科杂志,2019,(01):64.[doi:10.13798/j.issn.1009-153X.2019.01.022]
[8]柯燕燕　张春青　石先俊　安　宁　侯　智.影像导航下立体定向脑电监测在额叶癫痫中的应用…[J].中国临床神经外科杂志,2019,(09):513.[doi:10.13798/j.issn.1009-153X.2019.09.001]
　KE Yan-yan,ZHANG Chun-qing,SHI Xian-jun,et al.Application of stereoelectroencephalography under image-navigation to surgery for frontal lobe epilepsy[J].,2019,(10):513.[doi:10.13798/j.issn.1009-153X.2019.09.001]
[9]田海港　郭效东　王本瀚.迷走神经刺激术对药物难治性癫痫病人胃肠道功能的影响[J].中国临床神经外科杂志,2020,(02):103.[doi:10.13798/j.issn.1009-153X.2020.02.014]
[10]何文斌　沈云娟　张新定.眶额皮质相关癫痫的研究进展[J].中国临床神经外科杂志,2020,(12):886.[doi:10.13798/j.issn.1009-153X.2020.12.026]
[11]关宇光　于思科　刘长青　张　尧　陈思畅　丁浩然　周　健　栾国明.立体定向脑电图引导下射频热凝毁损术治疗药物难治性癫痫[J].中国临床神经外科杂志,2017,(06):369.[doi:10.13798/j.issn.1009-153X.2017.06.001]
　GUAN Yu-guang,YU Si-ke,LIU Chang-qing,et al.Stereotatic EEG-guided radio-frequency thermocoagulation of epileptogenic zones in the patients with refractory epilepsy[J].,2017,(10):369.[doi:10.13798/j.issn.1009-153X.2017.06.001]
[12]韩彦明　沈云娟　史　哲　刘亚丽　杨宝慧　王天成　张新定.神经节细胞胶质瘤相关癫痫的外科治疗[J].中国临床神经外科杂志,2021,26(07):505.[doi:10.13798/j.issn.1009-153X.2021.07.003]
　HAN Yan-ming,SHEN Yun-juan,SHI Zhe,et al.Surgical treatment for patients with ganglioglioma-related epilepsy[J].,2021,26(10):505.[doi:10.13798/j.issn.1009-153X.2021.07.003]
[13]丁慧超,管江衡,谢天浩,等.SEEG引导下RF-TC治疗脑室旁灰质移位症所致药物难治性癫痫（附2例报道并文献复习）[J].中国临床神经外科杂志,2023,28(07):421.[doi:10.13798/j.issn.1009-153X.2023.07.002]
　DING Hui-chao,GUAN Jiang-heng,XIE Tian-hao,et al.Clinical efficacy of stereotactic electroencephalogram guided radiofrequency thermocoagulation for refractory epilepsy caused by periventricular gray matter heterotopia: report of 2 case and literature review[J].,2023,28(10):421.[doi:10.13798/j.issn.1009-153X.2023.07.002]

备注/Memo

备注/Memo:
通讯作者：张　锐，E-mail：neurosurgeonzr@njmu.edu.cn
更新日期/Last Update: 1900-01-01