摘要目的 探讨立体脑电图(SEEG)引导下的射频热凝毁损技术在治疗脑室旁结节状灰质异位相关癫痫中的作用.方法 回顾性分析2015年3月至2017年5月北京丰台医院神经外科收治的5例脑室旁结节状灰质异位相关癫痫患者的临床资料.所有患者均根据症状学、头皮脑电图表现及影像学检查结果设计SEEG电极的植入方案,并行视频脑电监测,根据SEEG发作间期和发作期放电情况明确致痫灶的分布,根据其结果采用SEEG电极行射频热凝毁损术.术后通过门诊或电话进行随访,采用Engel分级进行预后评估.结果 5例患者共植入23根电极,植入后未见明显并发症.随访时间为9～ 27个月,其中4例癫痫发作消失(Engel分级Ⅰ级),1例毁损术后发作频率无明显改善(Engel分级Ⅳ级).所有患者在射频热凝毁损术中、术后均未出现明显不良反应.结论 立体定向脑电图(SEEG)引导下的射频热凝毁损技术对治疗脑室旁结节状灰质异位相关癫痫具有重要的临床应用价值.

abstractsObjective To investigate the seizure outcome in a case series of patients with periventricular nodular heterotopia related epilepsy treated by stereo-EEG (SEEG)-guided radio-frequency thermocoagulation (RF-TC).Methods Five patients with periventricular nodular heterotopia related epilepsy admitted to Department of Neurosurgery,Beijing Fengtai Hospital from March 2015 to May 2017 were retrospectively studied.Following video-EEG monitoring,patients underwent SEEG recording for further identification of epileptogenic zone.All patients underwent RF-TC of periventricular nodular heteropia using contiguous contacts of the electrodes employed for recording.The contacts for RF-TC lesions were chosen according to anatomical and electrical criteria.Postoperative follow-up was conducted by outpatient visits or telephone,and the prognosis was assessed by Engel classification.Results This cohort included 5 cases and 23 electrodes.No serious complications were observed after operation.During the follow-up of 9-27 months,4 patients were seizure-free (Engel Ⅰ),and 1 patient did not benefit from RF-TC (Engel Ⅳ).No obvious complications were reported during or after RF-TC in this series.Conclusions SEEG-guided RF-TC seems to have important clinical value in epileptogenicity validation and treatment of relatively limited periventricular nodular heterotopia.