基于导航立体定向脑电图在癫痫外科中应用-application of navigation-based stereotactic electroencephalogram in epilepsy surgery.docxVIP

优秀毕业论文 精品参考文献资料 基于导航的立体定向脑电图在癫痫外科中的应用 摘 要 目的 通过综合应用神经导航结合脑立体定向技术获取患者三维立 体脑电图以精确确定颅内致痫灶指导外科手术治疗,并观察在药物难 治性癫痫患者治疗中放置颅内电极与理论预设路径的位置准确性、安 全性、及定位致痫灶有效性。 方法 我科收治的 14 例难治性癫痫患者进行颅脑三维磁共振及头颅 静脉成像,利用 Brain-LAB 神经导航系统融合影像数据，建立立体大 脑及皮层静脉模型，设计路径避开大脑皮层表面血管，导航自动生成 靶点坐标，然后在 Leksell 立体定向框架下植入电极，计算电极植入 路径定位误差，并分析其安全性及有效性。 结果 14 例患者共植入 94 枚电极，所有电极均成功植入，主要并发 症是一例电极植入位置偏移导致的颅内少量出血及两例脑脊液漏，其 中一例继发颅内感染；进颅点误差中位数 1.64mm，四分位数间距 1.17-3.07mm ； 靶 点定位误差中位 数 2.74mm ，四分 位数间距 1.85-3.89mm，术后进行视频脑电监测及脑部电刺激，确定颅内致痫 灶并进行切除性手术（1 例双侧海马电刺激治疗），并进行术后随访。 结论 建立立体大脑及皮层静脉模有效避免电极植入出血并发症；立 体定向电极植入作为侵袭性评估致痫灶的方法安全、有效，并在行硬 膜下皮层电极植入术后效果不佳的病例中体现出优越性。 I  关键词：立体定向脑电图，神经导航，难治性癫痫，癫痫外科 II  PAGE 6 CLINICAL APPLICATION OF STEREO-ELECTROENCEPHALOGRAPHY BASED ON NEURO-NAVIGATION IN EPILEPSY SURGERY ABSTRACT Objective：To evaluate the safety,efficacy and the application accuracy of the Stereo-electroencephalography(SEEG) based on the Brain-Lab neuro-navigation in the preoperative evaluation of intractable epilepsy. Method ： Three-dimensional brain and Cortical vein model were established after the magnetic resonance imaging(MRI) and magnetic resonance venography(MRV) data of 14 patients with intractable epilepsy were imput into Brain-Lab nuero-navigation system in order to design the surgical path avoiding the Brain surface veins. SEEG operation was performed after obtaining target point and corrdinates. Quantitative analysis for target point and entry point localization error was performed and the safety,efficacy,complication were assessed． Result：Successful implantation were obtained in all cases and the patients’ epileptogenic zone were localized and removed(Deep brain stimulation in 1 case)．Major complication was intracranial hemorrhage (1case), cerebrospinal fluid leakage(2 cases, one was secondary  intracranial infection). Median entry point localization error was 1.64 mm (interquartile range, 1.17-3.07 mm).Median target point localization errors were 2.74mm (interquartile range, 1.85-3.89