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目的探讨长程视频脑电监测在下丘脑错构瘤诊断治疗中的应用意义。方法回顾性分析5例下丘脑错构瘤长程视频脑电(VEEG)特征,VEEG结合磁共振成像(MRI)、发作间期正电子发射计算机断层扫描(PET)检查诊断定位。结果发作间期清醒平静状态脑电图表现:双侧波形均呈不对称表现,双侧存在广泛单发性棘慢波或者双侧广泛不规则θ或δ波,一侧波幅优势,主要为一侧额叶优势,2例左侧优势,3例右侧优势,优势侧别同MRI显示的错构瘤侧别一致;睡眠期脑电图表现:存在基本睡眠标志波形与睡眠周期,间有较多量棘慢波或多棘慢波,存在形式同间期清醒平静状态;5例均捕获临床发作过程,共计13次,其中痴笑发作8次、痴笑发作继发全身强直阵挛5次,发作期脑电图表现:3例为去同步化低电压数秒后EEG混合肌电干扰,2例以肌电伪差为主。MRI结果:下丘脑脚间池处部位可见占位性改变,位于左侧半球2例、右侧半球3例。PET结果:MRI所提示的占位性改变区域均显示低代谢。5例均手术彻底去除错构瘤,随访5例患者术后均无痴笑发作或继发全身强直阵挛。结论长程视频脑电监测结合MRI及PET检查对下丘脑错构瘤诊断定位准确性高,手术治疗下丘脑错构瘤是最佳选择。
Objective To explore the significance of long-range video-electroencephalography in the diagnosis and treatment of hypothalamic hamartoma. Methods Five cases of hypothalamic hamartoma with long-term video EEG (VEEG), VEEG combined with magnetic resonance imaging (MRI) and inter-positron emission tomography (PET) were retrospectively analyzed. Results Intermittent awake state EEG performance: bilateral waveforms showed asymmetric performance, both sides there is a wide range of solitary spikes and slow waves or extensive bilateral wide θ or δ irregular wave, the side of the volatility, mainly for a Lateral frontal lobe superiority, left superiority in 2 cases, right superiority in 3 cases and superior side were consistent with those of hamartoma displayed by MRI. EEG in sleep stage showed that there was a difference between basic sleep sign wave and sleep cycle A large number of spikes and slow waves or more spikes and waves, there is the same state of awake and quiet between the seizures; 5 cases were captured during the clinical attack, a total of 13 times, of which 7 smoldering attacks, smoldering attacks secondary to systemic tonicerciasis 5 times, Electroencephalogram (EEG) showed three cases of EEG mixed electromyography (EEG) interference after a few seconds to synchronize low voltage, and two cases were mainly electromyogram artifacts. MRI results: Hypothalamus palpable pool site visible mass changes in the left hemisphere in 2 cases, 3 cases of the right hemisphere. PET Results: Regions of mass change indicated by MRI showed low metabolism. 5 patients were completely removed hamartoma surgery, follow-up of 5 patients were no smirk after surgery or secondary to tonic clonic. Conclusion Long-range video EEG monitoring combined with MRI and PET examination of hypothalamus hamartoma diagnostic accuracy, surgical treatment of hypothalamic hamartoma is the best choice.