ECoG联合深部电极监测在症状性癫痫手术中的应用及疗效影响因素分析
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广东省梅州市人民医院

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广东省医学科研基金项目(编号:A2018697)


Application of ECoG combined with deep electrode monitoring in refractory epilepsy surgery and analysis of influencing factors
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    摘要:

    [摘要]目的 探讨皮质脑电图(ECoG)联合深部电极监测在症状性癫痫手术中的应用及疗效影响因素分析。方法 回顾性分析2017年1月~2020年6月收治的24例行症状性癫痫手术患者的临床资料。术中采用ECoG联合深部电极监测并定位致痫灶,确定手术切除病灶深度、范围及周围致痫灶。术后随访6-12个月,采用Engel分级评估疗效,并根据疗效分为有效组(18例)、无效组(6例)。采用单因素分析、多因素Logistic回归分析症状性癫痫手术疗效的影响因素。结果 所有患者均顺利完成手术,术中ECoG、深部电极均监测到病变处阵发性或持续性棘慢复合波、棘波、尖波;此外,深部电极还在病变周围正常脑组织内监测到明显棘慢复合波、尖波,但放电程度及频率均较病变部位低。术后出现暂时性单侧肢体轻度偏瘫、语言障碍、情感淡漠各2例,术后2个月恢复正常,术后无严重感染及颅内出血等发生。多因素Logistic回归分析结果显示,病程>2年[OR:6.500,95%CI:1.741~24.274]、部分切除致痫灶[OR:14.583,95%CI:1.545~137.661]为症状性癫痫手术疗效的独立危险因素,而术后无早期发作[OR:0.066,95%CI:0.012~0.368]为症状性癫痫手术疗效的独立保护因素。结论 症状性癫痫手术术中采用ECoG联合深部电极监测可精准定位致痫灶深度及范围,具有较强实用性。患者病程、致痫灶切除程度、术后早期癫痫发作情况等为症状性癫痫手术疗效影响因素,临床中需结合以上因素进行准确评估并选择合理手术方案以提高手术疗效。

    Abstract:

    [Abstract]Objective To explore the application of cortical electroencephalogram (ECoG) combined with deep electrode monitoring in refractory epilepsy surgery and analysis of the factors affecting the efficacy.Method Retrospective analysis of the clinical data of 53 patients with refractory epilepsy surgery admitted from January 2017 to December 2019. During the operation, ECoG combined with deep electrodes was used to monitor and locate the epileptogenic foci, and determine the depth, scope and surrounding epileptogenic foci of the surgical resection. The postoperative follow-up was 12 months, and the therapeutic effect was evaluated by Engel classification, and divided into effective group (36 cases) and ineffective group (17 cases) according to the therapeutic effect. Univariate analysis and multivariate Logistic regression were used to analyze the influencing factors of surgical efficacy for refractory epilepsy.Results All patients successfully completed the operation. During the operation, ECoG and deep electrodes detected paroxysmal or persistent spinous and slow complex waves, spike waves, and sharp waves at the FCD lesion; in addition, deep electrodes were also monitored in normal brain tissue around FCD Obvious spine slow complex wave, sharp wave, but the discharge degree and frequency are lower than FCD part. After the operation, there were 2 cases of temporary unilateral hemiplegia, speech disorder, and apathy, and they returned to normal 2 months after the operation. No serious infection or intracranial hemorrhage occurred after the operation. Multivariate logistic regression analysis showed that the course of disease was more than 2 years [OR:6.500,95%CI:1.741~24.274], and partial resection of epileptic foci [OR:14.583,95%CI:1.545~137.661] was the curative effect of refractory epilepsy surgery The independent risk factors for patients with severe epilepsy and no early onset after surgery [OR:0.066,95%CI:0.012~0.368] are independent protective factors for the efficacy of surgery for refractory epilepsy.Conclusion The use of ECoG combined with deep electrode monitoring in the operation of refractory epilepsy can accurately locate the depth and range of the epileptic focus, which has strong practicability. The patient's course of disease, degree of epileptic foci resection, and early postoperative seizures are factors influencing the efficacy of refractory epilepsy surgery. In clinical practice, the above factors need to be accurately evaluated and a reasonable surgical plan should be selected to improve surgical efficacy.

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  • 收稿日期:2021-06-03
  • 最后修改日期:2021-07-22
  • 录用日期:2021-08-18
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