目的：初步探讨立体定向脑电图（ SEEG）在结节性硬化症（ TSC）患者癫痫术前评估中的应用。方法回顾性分析2例结节性硬化患者术前评估资料，将Leksell立体定向系统应用于立体定向电极置入，完成SEEG间歇期及发作期记录，确定致痫结节及手术切除范围，随访手术效果。结果病例1在额叶及顶、枕叶共置入立体定向电极7根，病例2在颞、枕叶共置入电极8根。置入过程顺利，患者耐受性好，未出现电极弯曲或折断，颅内血肿、感染等并发症。分别记录到9次和11次惯常发作，确定发作起始区分别为辅助感觉运动区和枕叶视觉皮层。术后随访3～5个月无癫痫发作。结论 Leksell立体定向系统指导下的立体定向电极置入具有微创，患者耐受性好，并发症少等优点，可以不受解剖位置的限制多点置入电极，可以到达深部或大脑半球内侧面以及脑沟裂的结节，能更好地诠释解剖-电-临床关系。 SEEG可能更适合于结节性硬化症所致难治性癫痫的术前评估。%Objective To explore the role of stereoelectro-encephalography ( SEEG ) in presurgical evaluation for tuberous sclerosis complex ( TSC) patients with epilepsy.Methods The clinical presurgical evaluation data of two TSC patients were analyzed retrospectively.In the two patients,the Leksell stereotactic system were used in the intracerebral multiple-contact electrodes implantation.Interictal and ictal SEEG recording were completed and the epileptic tubers and resection boundary were identified.The patients’ seizure outcome were followed up.Results Seven electrodes were implanted in frontal, parietal and occipital lobe of case 1.Eight electrodes were implanted in temporal and occipital lobe of case 2.The surgery went well and the patients had well tolerance.There was no complication such as intracranial hematoma and infection, no electrode bend or fracture.Nine and eleven habitual seizures were recorded respectively,and the onset zones were identified as SSMA and occipital visual cortex respectively.No seizures were reported after 3 or 5 months.Conclusions SEEG electrodes implantation guided by the Leksell stereotactic system has advantages of less invasive,better tolerance and less complication.The implantation would not be restricted by anatomical regions,and the electrodes could reach tubers in deep and meisal structures or those in sulci.Anatomo-electro-clinical correlations could be well explored by SEEG and it seems more appropriate for presurgical evaluation of TSC patients with epilepsy.
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