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目的总结分析MRI阴性难治性儿童额叶癫的脑电图特点及手术治疗方法和预后。方法回顾性分析25例MRI阴性难治性儿童额叶癫病例的治疗经验。根据病儿发作的症状及头皮脑电图特点,在可疑的癫灶起源区植入颅内电极,行皮质脑电图(ECoG)监测,根据其间期、发作期特点制定癫灶切除计划。病灶位于功能区时术中行皮质电刺激,进行癫灶及功能区定位。结果本组行单纯前额叶切除7例,前额叶切除加局限性皮质切除4例,局限性皮质切除加皮质热灼6例,前额叶外侧切除加局限性皮质切除3例,前额叶内侧切除加局限性皮质切除5例(其中3例加胼胝体切开);对其中6例灶位于功能区病人于局限性皮质切除后加行皮质热灼。无手术死亡及严重并发症发生,随访12～24个月,手术后疗效按Wilson标准评判,癫发作完全消失7例,发作次数显著减少8例,发作程度减轻6例,无明显改善4例;优良率为84%。结论分析头皮脑电图初步定位癫灶后,再应用颅内电极进行精确致灶及功能区定位,制定个体化治疗计划,选择前额叶切除、局限性皮质切除、皮质热灼、胼胝体切开或根据需要联合多种术式,是治疗MRI阴性难治性儿童额叶癫的有效方法。
Objective To summarize and analyze the characteristics of electroencephalography (EEG) and the surgical treatment and prognosis of frontal lobe epilepsy in MRI-negative refractory children. Methods Retrospective analysis of 25 cases of MRI-refractory children with frontal lobe epilepsy cases of treatment experience. According to the symptoms of the sick child and scalp EEG features, intracranial electrodes were implanted into the suspicious epileptic area, and ECoG monitoring was performed. According to the characteristics of interphase and exacerbation, the epileptic resection program . Focal lesions in the functional area during cortical electrical stimulation, epileptic foci and functional area positioning. Results In this study, there were 7 cases of simple frontal lobectomy, 4 cases of prefrontal resection plus limited cortical excision, 6 cases of localized cortical and cortical cauterization, 3 cases of lateral prefrontal cortex excision plus limited cystectomy, 5 cases of localized cortical resection (including 3 cases of corpus callosum incision); of which 6 cases of foci located in the functional area in patients with localized cortical excision plus cortical heat burning. No operative death and serious complications occurred. The patients were followed up for 12-24 months. The postoperative efficacy was evaluated by Wilson criteria. Seven cases of epileptic seizures disappeared completely, the number of seizures decreased significantly in 8 cases, the severity of seizures decreased in 6 cases, and no significant improvement in 4 cases The excellent and good rate was 84%. Conclusion After scalp EEG positioning of epilepsy, the intracranial electrode was used to locate the foci and the functional area accurately. Individualized treatment plans were made. The patients were divided into three groups: prefrontal cision, cortical excision, thermal cortex and corpus callosum Open or as needed combined with a variety of surgical procedures, is an effective method for the treatment of frontal lobe epilepsy in children with MRI-negative refractory.