CT与MRI图像融合辅助立体定向手术治疗难治性癫痫1.doc

CT与MRI图像融合辅助立体定向手术治疗难治性癫痫 郭效东 王本瀚 陆卫风 刘明辉 郝文明 吴艳芝 任廷文 杨俊国 赵学鼎 （解放军第153中心医院全军神经外科中心，河南 郑州 450042） 摘要 目的 探讨立体定向下颅内多靶点联合射频毁损术治疗难治性癫痫的疗效、安全性和并发症。方法 对65例难治性癫痫患者采用CT/MRI图像融合技术，手术计划系统确定颅内靶点，应用射频热凝对胼胝体、杏仁核、海马、Forel-H区、扣带回等多靶点组合毁损。术后长期随访，采用谭启富癫痫术后恢复评价标准及Engel(1987)评价标准进行疗效评定。结果 术后65例全部有效随访，随访时间3个月～6年，平均2.7年，满意5例(7%)，显著改善19例(29%)，良好26例(40%)，效差13例(20%)，无改善2例(3%)，有效率为96.6%；按Engel标准评价Ⅰ级6例(9%)，Ⅱ级23例(35%)，Ⅲ级34例(52%)，Ⅳ级2例(3%)。术后出现一过性并发症45例，经对症治疗均在1-4周内恢复，无永久性并发症。结论 CT与MRI图像融合辅助立体定向手术治疗难治性癫痫是一种安全、有效、微创的治疗方法。 关键词 图像融合；立体定向；难治性癫痫；疗效；射频毁损 Stereotactic radiofrequency ablation by CT and MRI image rebuilded and merged for refractory epilepsy Guo Xiaodong Wang Benhan L u Weifeng Liu Minghui Hao Wenming Wu Yanzhi Ren Tingwen Yang Junguo Zhao Xueding Department of Neurosurgery , 153rd Hospital of PLA, zhengzhou 450042, china Abstract Objective To assess the safety, efficacy and complications of stereotactic radiofrequency ablation of the intracranial multi-nucleus association for refractory epilepsy. Methods 65 refractory epilepsy patients were performed by using magnetic resonance imaging (MRI) and computed tomography (CT) image rebuilded and merged, operation planning system locating and combining intracranial target, for example corpus callosum, amygdaloid nucleus, amygdala and hippocampus, Forel-H field and cingulate gyrus, these gargets were lesioned by stereotactic radiofrequency ablation. All patients gained a long-time follow-up visits from three months to six years. Post-operation the clinical outcomes were assessed by evaluation criterion of professor Tan-Qi fu and Engel’s classification (1987). Results All of patients were followed up from 3 months to six years(mean, 2.7 years) normally, five cases of them (7%) were gratification, 19 patients (29%) were significant improvement, 26 patients (40%) were fine, and 13 cases (20%) were partial effect, another two cases were ineffective; according to Engel’s classification, six cases of them (9%) were Engel I, twenty-thr