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目的探讨术中B超联合皮层脑电图监测在颅内海绵状血管瘤继发癫痫患者显微外科手术中的应用价值。方法回顾分析2010年5月至2012年5月颅内海绵状血管瘤继发癫痫患者16例,术中采用B超指导手术切除病变,同时采用皮层脑电图监测确定致痫灶的部位和范围,并将其一并切除。结果 16例患者在术中B超监测下均能准确找到颅内海绵状血管瘤,并将病变全切除。所有患者在切病变前皮层脑电图监测均有大量的异常痫样放电,切除后复查皮层脑电图发现在病变周围仍然有痫样放电,但放电范围较切除前明显缩小。其中6例加行了周围皮层扩大切除术,8例加行了皮层热灼术,2例加行了MST。术后随访1~3年发现,15例患者无癫痫发作,效果较差1例。结论术中B超能帮助准确找到海绵状血管瘤,有助于病变全切除。而术中皮层脑电图监测使得在切除病变的同时,将致痫灶一并切除,这样既避开了功能区,减少了手术损伤,又有效控制了癫痫发作。
Objective To investigate the value of intraoperative ultrasound B-mode EEG monitoring in microsurgery for intracranial Cavernous hemangioma secondary epilepsy. Methods From May 2010 to May 2012, 16 patients with intracranial cavernous hemangioma secondary epilepsy were retrospectively analyzed. All the patients underwent B-guided surgery to remove the lesion. The location and extent of the epileptogenic focus were determined by cortical EEG monitoring , And cut it together. Results 16 patients under intraoperative B-ultrasound can accurately find intracranial cavernous hemangiomas, and lesions completely removed. All patients had a large number of abnormal epileptiform discharges before cortical EEG monitoring. After resection, cortical EEG showed that there was still epileptiform discharge around the lesion, but the discharge range was significantly reduced compared with that before excision. Among them, 6 patients underwent extended excision of the surrounding cortex, 8 patients underwent cortical cauterization, and 2 patients underwent MST. Follow-up 1 to 3 years after surgery found that 15 patients without epileptic seizures, the results were poor in 1 case. Conclusion Intraoperative B-can help accurately find cavernous hemangiomas, contribute to the total lesion. The intraoperative cortical EEG monitoring allows resection of lesions at the same time, the epileptogenic lesions will be removed together, so that not only to avoid the functional area, reducing surgical damage, but also effectively control the seizures.