摘要目的 探讨儿童药物难治性癫痫患者神经导航下颅内立体脑电图(SEEG)电极植入的精确性.方法 回顾性纳入深圳市儿童医院神经外科2016年3月至2017年12月采用神经导航下SEEG定位致痫灶的儿童难治性癫痫患者,共21例.采用MR表面注册法(9例)和CT解剖标志点注册法(12例)植入电极.比较两种注册方法电极植入的精确度,分析电极植入的深度(皮质入点至靶点的距离)与靶点误差及入点误差的相关性.结果 21例患者共植入139根电极.其中采用MR表面注册法植入电极56根,采用CT解剖标志点注册方法植入电极83根.MR表面注册组的注册时间、注册误差、电极入点误差、靶点误差分别为(37±9)min、(2.3±0.5)mm、(2.7±0.7)mm及(3.1±0.5)mm,CT解剖标志点注册组分别为(10±4)min、(1.1±0.3)mm、(1.5±0.5)mm、(2.2±0.6)mm.两组比较差异均有统计学意义(均P<0.05).139根电极中,电极植入深度为(4.7±1.7)mm,入点误差为(2.1±1.3)mm,靶点误差为(2.8±1.2)mm.相关性分析显示,电极植入深度与靶点误差呈正相关(r=0.57,P=0.034),与入点误差无相关性(r=0.27,P=0.121).全部患者电极植入后均无出血、感染等并发症.致痫灶切除术后随访6个月,Engel分级Ⅰ级者20例,Ⅱ级者1例.结论 儿童药物难治性癫痫患者在神经导航下的颅内SEEG电极植入精确度较高;相较于MR表面注册法,采用CT解剖标志点注册方法可提高注册效率和电极植入的精确度.

abstractsObjective To explore the accuracy of stereotactic electroencephalograph ( SEEG ) electrode implantation under neuronavigation in children with refractory epilepsy. Methods Twenty-one children with refractory epilepsy underwent SEEG electrode implantation for identification of epileptogenic zone at Neurosurgery Department of Shenzhen Children 's Hospital from March 2016 to December 2017 and were retrospective enrolled into this study MR surface registration and CT registration with anatomic markers were used for the electrode implantation. The accuracy of electrode implantation was compared between the 2 registration methods. The correlation between the depth of electrode implantation ( the distance from cortical entry point to target) and the error of target and the error of entry point was analyzed. Results A total of 139 electrodes were implanted in 21 patients. Among them, 56 electrodes were implanted by MR surface registration method, and 83 implanted electrodes were placed by CT anatomical marker registration method. The registration time, registration error, electrode entry error and target error of MR Surface registration group were (37 ± 9) min, (2. 3 ± 0. 5) mm, (2. 7 ± 0. 7) mm and (3. 1 ± 0. 5) mm; those in anatomical marker registration group were (10 ± 4) min, (1. 1 ± 0. 3) mm, (1. 5 ± 0. 5) mm, (2. 2 ± 0. 6) mm respectively. The differences were statistically significant (all P<0. 05) in the comparison between the 2 groups. In 139 electrodes, the electrode implantation depth was (4. 7 ± 1. 7) mm, the entry point error was (2. 1 ± 1. 3) mm, and the target error was (2. 8 ± 1. 2) mm. Correlation analysis showed that the depth of electrode implantation was positively correlated with the target error (r=0. 57, P=0. 034), and there was no correlation with the error of the entry point (r = 0. 27, P = 0. 121). None of the patients had complications such as bleeding and infection after electrode implantation. After epileptogenic zonectomy, all patients were followed up for 6 months and included 20 cases as Engel Ⅰ and 1 case as Engel Ⅱ.&nbsp;Conclusion In children with refractory epilepsy, the accuracy of SEEG electrode implantation under neuronavigation seems to be relatively high. Compared with MR surface registration method, the registration efficiency and the accuracy of electrode implantation can be improved by using CT anatomical marker registration.