脑磁图联合颅内电极脑电图在癫痫外科治疗中的应用

摘要

Objective To explore the application of magnetoencephalography ( MEG ) combined with intracranial EEG ( iEEG) in epilepsy surgery.Methods MEG was applied to the presurgical evaluation of the intractable epilepsy patients who were underwent intracranial electrodes implant-ation.Implantation plans were designed based on the electrical-clinical semiology,neuroimaging, EEG findings and MEG of the patients, followed by electrodes implantation and long-term monitoring for ictal iEEG.Results Epilepsy surgery was performed in 38 patients by the protocol at last.Of 16 patients with temporal lobe epilepsy ( TLE) , there were 6 whose MEG results were concordant with iEEG, while in 22 non-TLE(NTLE) there were 16,which showed significant difference.After the long-term follow-up, results of seizure control showed 28 cases was Engel ClassⅠ,5 ClassⅡ, 3 ClassⅢand 2 Class Ⅳ.Conclusions There is higher concordance rate between MEG and iEEG in NTLE patients than in TLE patients.Distinguished from other noninvasive examinations like Vedio-EEG, MRI and so on, MEG can provide additional guidance to the electrodes implantation plan.Application of MEG combined with intracranial EEG will make the implantation plan more precise , more pointed, and remarkablely improve the efficiency of the epilepsy surgery.%目的：研究脑磁图（ MEG）与颅内电极脑电图（ iEEG）联合在癫痫外科治疗中的应用价值。方法应用MEG参与到将行颅内电极埋置患者的术前评估中：根据电-临床症状学、影像学、脑电图、MEG等结果设计出颅内电极埋置方案，进而行颅内电极置入并监测iEEG，捕捉发作期，最终根据定位结果行手术治疗。结果最终成功定位癫痫发作起始区并手术治疗者38例。其中证实为颞叶癫痫（ TLE）的16例中，MEG与iEEG定位一致者仅6例，而颞叶以外癫痫（ NTLE）22例中两者一致者达16例，两组结果有统计学差异。所有患者术后随访：Engel Ⅰ级28例，Ⅱ级5例，Ⅲ级3例，Ⅳ级2例。结论 MEG运用于NTLE时较TLE有着更高的与iEEG的一致率。区别于视频脑电图、MRI等其它的无创检查，MEG能够对有创的iEEG电极埋置起到额外指导作用。 MEG与iEEG联合，能使电极埋置更合理精确、有针对性，能获得较高的癫痫手术疗效。