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目的探讨利用fMRI导航结合皮质电极描记切除功能区及其附近癫癎灶的临床疗效。方法回顾性分析11例癫癎灶起源于功能区及其附近的癫癎病人的手术经验。病人术前发作频率(2.63±1.68)次/月。术前利用fMRI检查确定功能区位置并与导航图像进行融合,术中使用皮质电极描记标记出癫癎波的位置,通过导航系统了解功能区与癫癎波起源的关系。在保留功能区皮质的基础上,将病灶和癫癎波起源处皮质切除,而位于功能区皮质上的癫癎波起源处则给予小功率皮质热灼。结果皮质发育不全8例,灰质异位症2例,脑外伤后局部皮质软化1例。术后随访6～12个月,癫癎发作完全消失9例,术后3～6d内发作1次2例,随后未再出现癫癎发作。术后未出现明显的神经功能损害加重的情况。术后3个月复查脑电图显示基本正常。结论fMRI导航结合皮质电极描记切除起源于功能区及其附近的癫癎灶是一种微侵袭的手术方法,在切除癫癎灶的同时能最大限度地保留功能区的神经功能。
Objective To investigate the clinical efficacy of fMRI navigation combined with cortical electrode in the resection of functional areas and its adjacent epileptic foci. Methods Retrospective analysis of 11 cases of epileptic foci originated in the functional area and the epilepsy patients near the surgical experience. The frequency of preoperative seizure was 2.63 ± 1.68 times / month. The fMRI was used to determine the location of the functional area before surgery and fuse with the navigation image. The location of the epileptic wave was marked by cortical electrodeposition during operation. The relationship between the functional area and the origin of epileptic wave was found by navigation system. On the basis of retaining the functional cortical area, the cortex of the lesion and the epileptic wave origin is excised, while the epileptic origin located on the cortex of the functional area is given cauterization of the low-power cortex. Results Cortical hypoplasia in 8 cases, 2 cases of gray matter edema, partial cortical softening after traumatic brain injury in 1 case. All the patients were followed up for 6 to 12 months. There were 9 cases of epileptic seizures disappearing completely and 2 cases of seizures occurred within 3 ~ 6 days after operation. No seizure occurred after that. No obvious postoperative neurological impairment worsened. 3 months after the review EEG showed normal. Conclusion fMRI navigation combined with cortical electrode debridement of epileptic foci originated in the functional area and its vicinity is a minimally invasive surgical method that can retain the nerve function of the functional area as much as possible while removing the epileptic foci.