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目的研究立体定向下开放式手术联合术中皮层脑电图(ECoG)监测治疗颅内钙化灶性癫痫的手术方法、注意事项及效果。方法 21例颅内单发钙化灶引起的癫痫患者(其中主要功能区钙化灶9例),在立体定向仪导向下,开放直视手术,ECoG监测钙化灶周围皮层脑电活动情况,切除钙化灶后再次ECoG监测,确定致痫灶的范围及处理方式。结果所有钙化灶均被顺利切除。钙化灶区域ECoG监测无明显异常5例,表现为阵发性与动脉搏动相一致的单发性棘慢复合波发放9例,表现为明显癫痫样放电7例。单纯钙化灶切除术14例,钙化灶+周边增生组织+致痫皮层切除术4例,钙化灶切除+功能区致痫皮层低功率电凝热灼术3例。术后ECoG监测发现异常放电消失11例,仍残存轻中度痫样放电5例。无严重并发症。随访6个月～8年,EngelⅠ级16例,EngelⅡ级5例,总有效率100%。结论 ECoG监测是立体定向下手术治疗颅内钙化灶性癫痫的重要辅助手段,能够指导术中采取相应的手术方式切除钙化灶,妥善处理致痫灶,避免过多损伤脑皮层。
Objective To study the surgical methods, precautions and effects of open surgery combined with intraoperative cortical electroencephalogram (ECoG) monitoring for intracranial calcification-induced epilepsy under stereotactic conditions. Methods 21 cases of intracranial single calcification-induced epilepsy patients (including the main function of the calcification in 9 cases), under the guidance of stereotactic apparatus, open surgery, ECoG monitoring calcification around the cortex EEG activity, removal of calcification After another ECoG monitoring, to determine the scope and treatment of epileptogenic lesions. Results All calcifications were successfully removed. Five cases of ECoG in the calcification area showed no obvious abnormalities. Nine cases showed paroxysmal sporadic slow-wave solitary waves consistent with arterial pulsation. Seven cases showed obvious epileptiform discharges. Simple calcification in 14 cases of calcification, calcification + peripheral hyperplasia + epilepsy cortex resection in 4 cases, calcification + functional area induced epilepsy cortex low power electrocautery cautery in 3 cases. Eleven cases of abnormal discharge disappeared after ECoG monitoring, and 5 cases remained mild to moderate epileptiform discharge. No serious complications. Followed up for 6 months to 8 years, Engel Ⅰ 16 cases, Engel Ⅱ 5 cases, the total efficiency of 100%. Conclusion ECoG monitoring is an important auxiliary method for stereotactic treatment of intracranial calcification-related epilepsy under stereotactic operation. It can guide the corresponding surgical procedures to remove calcification, properly handle epileptogenic lesions and avoid excessive damage to the cerebral cortex.