OBJECTIVE:To summarize the clinical features of collagen type IV alpha 1/2 chain (COL4A)1/2-related epilepsy and the seizure outcomes of patients undergoing epilepsy surgery. METHODS:We retrospectively analyzed the clinical, electroencephalography, and neuroimaging data; genetic characteristics; surgical details; and prognosis of 8 patients (4 boys) treated for COL4A1/2-related epilepsy at Tsinghua University Yuquan Hospital. RESULTS:Two of the probands had COL4A1 variants and six had COL4A2 variants. Four of the variants were de novo. Prenatal abnormalities consisted of intrauterine growth retardation and ventriculomegaly. Three patients had a low birth weight, and one had perinatal retinal hemorrhage. The median age of seizure onset was 8 months, with 75% (6/8) experiencing epilepsy before age 1. Status epilepticus occurred in 38% (3/8) of patients. All patients experienced focal seizures, and 50% (4/8) had focal epileptic spasms. Hemiparesis was observed in 88% (7/8) of patients, and all 8 had developmental delays. The median number of anti-seizure drugs was 5, and all patients had drug-resistant epilepsy. Seven patients had seizures localized to one of the posterior quadrants, consistent with the magnetic resonance imaging features of blurring of the gray-white matter junction and positron emission tomography features of metabolic abnormalities. Other neuroimaging features included bilateral mild white matter abnormalities; unilateral porencephaly near the basal ganglia; ventriculomegaly; focal cerebral calcification; contralateral schizencephaly; and contralateral cortical thickening and cerebellar abnormalities. Six patients underwent unilateral posterior quadrant disconnection, five (83%) of whom had no recurrence for at least 11 months and experienced developmental improvement. No surgical complications were reported. Pathological examination revealed malformations of cortical development in all six surgical cases (five with focal cortical dysplasia [FCD] type Ia and one with FCD type II). SIGNIFICANCE:The results of this case series suggest that early surgical intervention in patients with COL4A1/2-related epilepsy with well-defined epileptogenic zones may improve seizure control and developmental outcomes. PLAIN LANGUAGE SUMMARY:In this case series of eight patients, epilepsy related to variants in the collagen type IV alpha 1/2 chain genes was characterized by drug-resistant localized seizures with an early onset, one-sided muscle weakness, and developmental delay. Neuroimaging revealed various brain abnormalities. Structural abnormalities outside the seizure-onset zone did not appear to affect surgical prognosis. Early surgical intervention in patients with well-defined seizure-onset zones improved seizure control and developmental outcomes.

OBJECTIVE:Tuberous sclerosis complex (TSC) causes focal drug-resistant epilepsy. Prediction of which tubers are epileptogenic remains challenging. We used stereoelectroencephalography (SEEG) to investigate epileptogenic zone (EZ) organization in TSC-related epilepsy, focusing on epileptogenicity of different tuber radiological subtypes. METHODS:We retrospectively studied consecutive patients with TSC-related epilepsy explored by SEEG. Presence of "focal EZ" (comprising "focal tuber," "tuber-plus," and "focal nontuber") or "diffuse EZ" was determined. In focal EZ involving tubers, interictal and ictal epileptogenic biomarkers were compared to the radiological appearance of tubers. In addition to four previously described tuber subtypes, we propose a novel subtype: type E (focal cortical depression, hypointense base on T2/fluid-attenuated inversion recovery). RESULTS:Among 63 patients, 55 (87.3%) patients exhibited focal EZ, including focal tuber (n = 32, 50.8%), tuber-plus (n = 11, 17.5%), and focal nontuber (n = 12, 19.0%, of which 7/12 involved focal cortical dysplasia [FCD]). In the 43 of 63 (68.3%) patients with focal EZ involving at least one tuber, epileptogenicity of 265 explored tubers was analyzed with regard to radiological subtypes. Tuber subtypes A and B were most prevalent (186/265, 70.2%) but among the least epileptogenic on SEEG. The highest ictal epileptogenicity was in subtypes D (77.8%) and E (77.5%) compared to type A/B/C (Fisher exact test; all p < .05). Type D/E tubers exhibited higher interictal biomarkers than type A/B/ C (linear mixed model; p < .05). In patients with focal EZ, following surgical intervention, 36 of 55 (65.5%) achieved Engel class I outcomes, with a higher odds ratio of Engel I in the combined group of focal tuber/focal nontuber compared to tuber-plus EZ (p < .05). SIGNIFICANCE:Most TSC-related epilepsy represents focal EZ related to tubers, but focal extratuber EZ can also occur (FCD or hippocampus). Radiologically, calcified tubers (type D) and tubers with focal cortical depression and central hypointensity (type E) exhibit the highest epileptogenicity, similar to FCD type II.

In MRI-guided laser interstitial thermotherapy (MRgLITT), a signal void sometimes appears at the heating center of the measured temperature map. In neurosurgical MRgLITT treatments, cerebrospinal fluid pulsation (CSF), which may lead to temperature artifacts, also needs to be carefully managed. We find that signal loss in MR magnitude images can be one distinct contributor to the temperature imaging signal void. Therefore, this study aims to investigate this finding and more importantly. Also, this study intends to improve measurement accuracy by correcting CSF-induced temperature errors and employing a more reliable phase unwrapping algorithm. A gradient echo sequence with certain TE values for temperature imaging is used to quantify T2* variations during MRgLITT and to investigate the development of signal voids throughout the treatment. Informed by these findings, a multi-echo GRE sequence with appropriate TE coverage is employed. A multi-echo-based correction algorithm is developed to address the signal loss-induced temperature errors. A new phase unwrapping method and a new CSF pulsation correction approach are developed for multi-echo signal processing. The temperature imaging method is evaluated by gel phantom, ex-vivo, and in-vivo LITT heating experiments. T2* shortening during heating can be one important cause of the temperate imaging signal voids and this demands the multi-echo acquisition with varied TE values. The proposed multi-echo-based method can effectively correct signal loss-induced temperature errors and raise temperature estimation precision. The multi-echo thermometry in the in-vivo experiments shows smoother hotspot boundaries, fewer artifacts, and improved thermometry reliability. In the in-vivo experiments, the ablation areas estimated from the multi-echo thermometry also show satisfactory agreement with those determined from post-ablation MR imaging.

Cerebrovascular segmentation based on phase-contrast magnetic resonance angiography (PC-MRA) provides patient-specific intracranial vascular structures for neurosurgery planning. However, the vascular complex to-pology and spatial sparsity make the task challenging. Inspired by the computed tomography reconstruction, this paper proposes a Radon Projection Composition Network (RPC-Net) for cerebrovascular segmentation in PC-MRA, aiming to enhance distribution probability of vessels and fully obtain the vascular topological informa-tion. Multi-directional Radon projections of the images are introduced and a two-stream network is used to learn the features of the 3D images and projections. The projection domain features are remapped to the 3D image domain by filtered back-projection transform to obtain the image-projection joint features for predicting vessel voxels. A four-fold cross-validation experiment was performed on a local dataset containing 128 PC-MRA scans. The average Dice similarity coefficient, precision and recall of the RPC-Net achieved 86.12%, 85.91% and 86.50%, respectively, while the average completeness and validity of the vessel structure were 85.50% and 92.38%, respectively. The proposed method outperformed the existing methods, especially with significant improvement on the extraction of small and low-intensity vessels. Moreover, the applicability of the segmen-tation for electrode trajectory planning was also validated. The results demonstrate that the RPC-Net realizes an accurate and complete cerebrovascular segmentation and has potential applications in assisting neurosurgery preoperative planning.

Objective:To record stereoelectroencephalography (SEEG) data and to induce cortical electrical stimulation in children with tuberous sclerosis complex (TSC), thus exploring the epileptogenicity of different types of cortical tubers.Methods:The SEEG recording and cortical electrical stimulation data of 50 children with TSC who underwent preoperative evaluation for drug-resistant epilepsy at Epilepsy Center, Tsinghua University Yuquan Hospital from November 2016 to September 2022 were retrospectively analyzed, involving 27 boys and 23 girls with the age of (5.5±3.4) years.According to the results of 3.0T magnetic resonance imaging (3T-MRI) and computed tomography(CT), cortical tubers were classified.The incidences of electroclinical seizures, electrical seizures and seizures induced by cortical electrical stimulation in different types of tubers recorded by SEEG were analyzed, and the differences in the proportion of the above seizures among different types of tubers were compared using the Fisher′ s exact test. Results:A total of 303 cortical tubers were explored using SEEG in 50 patients.The tubers were divided into 6 types, including Type A, B, C, D and E, and focal cortical dysplasia like (FCD-like) type, among which Type E was for the first time proposed in the world.Among these explored tubers, 7 tubers had electrical seizures, and 57 tubers had electroclinical seizures.A total of 64 tubers (21.1%) were epileptogenic.The incidence of epileptogenic tubers in Type A-E and FCD-like type were 3.6%, 1.4%, 19.0%, 77.8%, 77.5%, and 90.0%, respectively. Fisher′ s exact test and Bonferroni correction were performed for pairwise comparisons( P<0.003). There was no significant difference in the incidence of epileptogenic tubes among Type A, B and C. There was significant difference in the incidence of epileptogenic tubes between Type A-C with Type D, Type E and FCD-like type, respectively.There was no significant difference in the incidence of epileptogenic tubes between Type D, Type E and FCD-like like.Electrical stimulation-induced seizures occurred in 36 cortical tubers (11.9%). The positive rate of electrical stimulation seizures in Type A-E and FCD-like type were 0.7%, 1.4%, 4.8%, 44.4%, 45.0%, and 70.0%, respectively.There was significant difference in the positive rate of electrical stimulation seizures between Type A-B and Type D, Type E and FCD-like type, respectively, so as that between Type C versus Type E and FCD-like type.No significant difference in the positive rate of electrical stimulation seizures was found between other pairwise comparisons. Conclusions:This study proposed a new classification of cortical tubers in TSC patients, and Type E is proposed for the first time in the world.SEEG records confirmed great differences in epileptogenicity indifferent types of cortical tubers.Type D, Type E and FCD-like type have higher epileptogenicity, which is of great value for the preoperative evaluation of TSC epilepsy surgery and the placement strategy of SEEG electrodes.

目的 总结起始于运动前区皮层(PMC)癫痫的电临床特征.方法 回顾性分析2014年5月一2021年1月在清华大学玉泉医院行术前评估并经颅内电极脑电图证实起始于运动前区皮层的6例难治性癫痫患者的临床资料,包括症状学、头皮及颅内脑电图、影像学、手术及随访,并将6例患者分成腹侧组、背侧组、内侧面组3组进行比较.结果 腹侧组有3例患者,背侧组有1例患者,内侧面组有2例患者.腹侧组症状较多,包括过度运动、面部强直(撇嘴)、肢体强直、偏转;内侧面组主要为单侧或双侧肢体非对称强直.头皮脑电图主要为前头部(额中央区)放电.3例MRI阴性,3例MRI提示局灶性皮质发育不良.6例患者均行PET-CT检查,2例有代谢减低区.5例患者行致痫区切除,术后病理均为局灶性皮质发育不良(FCD),1例为FCD Ⅰ型,其余均为FCD Ⅱ型.5例手术切除患者术后随访无发作,未手术切除的1例患者先后行热凝和激光治疗,治疗当天发作即消失.结论 运动前区癫痫发作主要为运动症状,越靠近腹侧,症状越复杂,如过度运动、偏转、面肌强直(撇嘴);越近内侧面,症状越简单,以单侧或双侧肢体强直多见.借助于颅内电极,准确定位,局限性皮层切除可以取得较好的预后,另外,对于运动前区沟底FCD,激光等微创技术也有较好的治疗效果.

背景 眶额皮质(Orbitofrontal cortex,OFC)是大脑皮层中被研究最少的区域之一,而起始于眶额的癫痫发作,特别是起始于眶额不同部位癫痫的电临床特点还不被人们熟悉.其主要原因可能是由于眶额解剖分区的复杂性、病例罕见、头皮电极很难记录到该部位放电而需要进一步颅内电极的植入来明确发作起始.

目的 利用比格犬动物实验,探讨采用国产激光消融治疗系统(LS1)和激光消融微创治疗套件(LS—T1)行磁共振引导下激光间质内热疗的安全性和有效性.方法 健康比格犬15只,行3T磁共振引导下激光间质内热疗,功率8W时间50 s,消融过程中磁共振实时扫描监测消融区域温度,系统软件计算最大消融横截面面积.消融后行增强T1磁共振扫描,测量增强毁损灶最大横截面面积.实验结束2周后安乐死比格犬,测量切片最大消融横截面积.对比分析系统计算、术后3D增强T1及切片测量的最大消融横截面积.结果 15只比格犬实验后均正常存活,系统计算最大消融截面面积为115.8±9.9 mm2,增强T1显示最大消融截面面积为115.7±1.0mm2,激光消融2周后组织切片最大消融截面面积为112.7±9.5 mm2.系统计算最大横截面积与增强T1显示最大横截面积差异无统计学意义(P=0.91),系统计算最大横截面积与切片测量最大横截面积差异有统计学意义(P＜0.01),增强T1显示最大横截面积与切片测量最大横截面积之间差异有统计学意义(P＜0.01).结论 应用国产激光消融治疗系统行磁共振引导下激光热疗是安全有效的,系统计算消融面积与消融后增强T1显示消融面积无明显差异.

Objective:To summarize the surgical treatment of tuberous sclerosis with refractory epilepsy in 42 children.Methods:Forty-two children who were clinically and pathologically diagnosed with tuberous sclerosis with refractory epilepsy in Yuquan Hospital from April 2008 to March 2019 were selected. All children underwent magnetic resonance imaging, 41 underwent long time video electroencephalogram (EEG) monitoring, and 30 underwent genetic examination. All children underwent detailed preoperative evaluation, and either direct resection or intracranial electrode thermocoagulation was then selected.Results:Among the 42 children, 31 (73.8%) had Engel grade Ⅰ, 6 (14.3%) had grade Ⅱ, 3 (7.1%) had grade Ⅲ, and 2 (4.8%) had grade Ⅳ. Among the 31 children without seizures, 19 had EEG abnormality, among whom 16 cases had discharge, 3 cases had EEG abnormality in 1 year, but returned to normal after 1 year. The EEG of the other 12 children was normal after operation. One case of generalized seizure was free of seizure in 6 years after surgery.Conclusion:The epileptogenic foci of tuberous sclerosis with refractory epilepsy in children are usually single or have major localized areas. Detailed preoperative evaluation can accurately identify the epileptogenic nodules and help obtain a good surgical effect.

To better understand the electroclinical features and epileptic network of lateral and medial orbitofrontal epilepsy (OFE). We evaluated four patients who had undergone epilepsy surgery. Epileptic foci in two patients originated from the lateral orbitofrontal cortex, and those in the other two originated from the medial orbitofrontal cortex, which was confirmed by stereoelectroencephalography (SEEG). Time-frequency spectrograms were also provided for assistance, and the change in high-frequency energy was superimposed on the 3D reconstructed brain with a colour code in order to more intuitively show the transfer of high-frequency energy as the seizure evolves. All patients underwent SEEG-guided radiofrequency thermocoagulation (RF-TC) or focal resection and achieved satisfactory results. Lateral OFE and medial OFE were relatively independent with regards to clinical symptoms and epileptic network, however, lateral OFE was likely to propagate to the dorsolateral frontal lobe, whereas medial OFE (gyrus rectus) was more likely to propagate to the medial temporal lobe or insular lobe with long duration. There were significant differences in duration (21.17 ± 11.5 vs. 127.22 ± 235.05) and early propagation time (7.92 ± 4.44 vs. 29.0 ± 33.47) between the two origins. A better understanding of the electroclinical features of lateral and medial OFE is helpful to understand their epileptic networks and perform accurate resections in order to protect the cognitive and behavioural functions of patients.

Objective:To explore the therapeutic efficacy of comprehensive treatment for the giant tumor involving the third ventricle in infants and young children.Methods:A retrospective analysis was conducted on 16 patients ≤ 3 years old who underwent surgical treatment for giant tumors of the third ventricle at Department of Neurosurgery Center, Tsinghua University Yuquan Hospital from January 2013 to June 2019. Pathological examination indicated that there were 8 cases of germ cell tumor, 4 cases of pineoblastoma, 2 cases of astrocytoma and 2 cases of choroid plexus papilloma. Among them, 8 patients underwent ventriculoperitoneal shunting and 2 underwent ventriculoscopic third ventriculostomy prior to tumor resection. All tumors were resected through transcallosal interforniceal approach. There were 3 patients undergoing neoadjuvant chemotherapy before operation and 10 undergoing adjuvant chemotherapy after operation.Results:Total removal of the tumor was achieved in all 16 cases. Postoperative complications included subdural effusion in 11 cases and respiratory dysfunction in 3, all of which improved following treatment. Of the 3 children with preoperative chemotherapy, 2 were reduced in tumor volume and 1 increased in tumor volume after chemotherapy, and 3 cases showed that the tumor blood supply was not abundant and local necrosis change was reported. Postoperative pathological examination revealed degeneration and necrosis of focal tumor cells and vascular wall. One case was lost to postoperative follow-up and 15 were followed up for 72 months (median: 18 months). Three cases of pineoblastoma died within 10 months of surgery due to wide dissemination of tumor in the subarachnoid space, and none of the remaining 12 cases had relapsed.Conclusions:Tumors involving the third ventricle can be safely and totally resected via the transcallosal interforniceal approach. Microsurgical resection can be facilitated by preoperative neoadjuvant chemotherapy for some malignant brain tumors and postoperative chemotherapy may reduce tumor recurrence.

Pediatric brain tumors are a type of tumors that are commonly present in children and young adults. With the improvement of treatment, the quality of life, especially the cognitive functioning, is gaining increasingly more attention. Apart from cognitive evaluations, neuroimaging studies begin to play an important part in neurocognitive functioning investigation. In this way, the brain tissue changes caused by tumor variables（including tumor location and tumor size） and treatment variables（including surgery, chemotherapy and radiotherapy） can be detected by neuroimaging. Recent advancement of neuroimaging techniques, such as functionalMRI（f MRI） and diffusion tensor imaging（DTI）, made great contributions to understanding cognitive dysfunction and quantifying the effects of tumor variables and treatment variables. In recent years, laminar-f MRI provided a potentially valuable tool for examining the exact origins of neural activity and cognitive function. On the other hand, molecular f MRI might guide diagnosis and treatment of brain disease in the future by using new biomarkers, and DTI can detect white matter changes and obtain some anatomically specific information.

Stereoelectroencephalography（SEEG） has been widely used in the presurgical evaluation of patients with medically intractable epilepsy. In the past, SEEG was commonly used as a method for mapping and localizing the epileptogenic zone（EZ）. Since 2004,several studies have been conducted to examine the effectiveness of SEEG-guided radiofrequency thermocoagulation（RF-TC） in treating refractory epilepsy. However, the seizure-free and responder rates varied greatly across studies. We aimed to analyze the outcome of 56 patients who were treated with SEEG-guided RF-TC to evaluate the effectiveness of this treatment. SEEG-guided RF-TC can be considered as a treatment for refractory epilepsy. However,due to its limited efficacy, SEEG-guided RF-TC might be regarded as a temporary treatment performed under SEEG rather than a promising treatment for refractory epilepsy.

The best results of stereoelectroencephalography (SEEG)-guided radiofrequency thermocoagulation (RF-TC) were observed in epilepsies with more limited lesions, but this procedure is rarely used in a wide range of brain malformation. We report a rare case of polymicrogyria (PMG) combined with drug-resistant startle seizures. Presurgical monitoring was performed using SEEG owing to the large lesion and complexity of PMG. According to the intracranial electrode results, the seizure onset was extensive, with the onset starting earlier in the cingulate sulcus and insular pole than in other sites of the other electrodes. Multi-point and multi-step SEEG-guided RF-TC was used for diffuse lesion and functional protection. RF-TC was first applied to the cingulate sulcus and insular pole, and our patient was rendered free from startle seizures after 2 weeks. Two weeks of observation helped us to observe the efficacy of RF-TC and the changes of SEEG, so as to make the next TC scheme. The patient still had spontaneous seizures after the first treatment. RF-TC was then applied to other sites involved earlier. Finally, the patient reached Engel class IIa for a follow-up period of 1 year. There were no additional startle seizures, and important functional areas were protected.

Objective: The present study investigated the electroclinical features and epileptogenic networks of parietal operculum seizures (POS) by using stereoelectroencephalography (SEEG) intracerebral recordings. Methods: Comprehensive presurgical evaluation data of seven patients with drug-resistant epilepsy with POS were analyzed retrospectively. Stereoelectroencephalography-recorded seizures were processed visually and quantitatively by using epileptogenicity mapping (EM), which has been proposed to ergonomically quantify the epileptogenicity of brain structures with a neuroimaging approach. Results: Six patients reported initial somatosensory or viscerosensitive symptoms. !dal clinical signs comprised frequently nocturnal hypermotor seizures and contralateral focal motor seizures, including tonic, tonic-clonic, or dystonic seizures of the face and limbs. lnterictal and ictal scalp EEG provided information regarding lateralization in the majority of patients, but the discharges were widely distributed over perisylvian or "rolandic-like" regions and the vertex. Furthermore, two subgroups of epileptogenic network organization were identified within POS by SEEG, visually and quantitatively, using an EM approach: group 1 (mesial frontal/dngulate networks) was observed in three patients who mainly exhibited hypermotor seizures; group 2 (perisylvian networks) was observed in four patients who mainly exhibited contralateral focal motor seizures. Conclusion: This study indicated that POS could be characterized by initial specific somatosensory sensations, followed by either frequently nocturnal hypermotor seizures or contralateral focal motor seizures. The distinctive seizure semiology depended on the organization of two primary epileptogenic networks. (C) 2018 Elsevier Inc. All rights reserved.

Objective To investigate the clinical value of MRI morphological analysis in identification of focal cortical dysplasia (FCD) in presurgical evaluation of epileptogenic zone (EZ).Methods We retrospectively analyzed the clinical data of 53 patients who were admitted to Epilepsy Center,Tsinghua University Yuquan Hospital and underwent surgical removal of epileptic foci and were pathologically confirmed as FCD Ⅰ or FCD Ⅱ.Morphometric analysis programme was used to post-process presurgical high-resolution MRI to obtain the gray-white matter junction imaging (MAP+ region) and statistical analysis was used to determine the consistency of the MAP + region and surgical site and postoperative epilepsy control.Results In this series,the probability of postoperative seizure-free (67.9％,36/53) was higher in patients whose MAP* regions were resected than that (7.5％,4/53) in patients whose MAP+ regions were not resected (P=0.002).In the MRl-negative group,the probability of postoperative seizure-free (62.5％,20/32) was higher in patients whose MAP+ regions were resected than that (9.4％,3/32) in patients whose MAP+ regions were not resected (P =0.006).In the MRI positive group,MAP+ regional resection was not associated with the clinical outcome (P =0.352).Conclusions The gray-white matter junction imaging could improve the detection rate of FCD lesions,which might have clinical value in localization of EZ and resection of EZ and making electrode plan of stereotactic electroencephalogram (SEEG).

Objective Exploration of a cerebral stratified reconstruction method for precise identification and localization of critical brain regions that cannot be directly visible by open skull surgery.Methods The neuroimaging system Neurotech was employed to display the 3D brain imaging of the patients,revealing the detailed information such as the scalp,the shape and sickness of skull ,the sature of skull,blood vessel of the scalp and brain,the shape of gyrus.Neurosurgeons then decided on the brain regions need to be resected on the 3D images and designed ways of operation including the incision,the position of burr hole,where and how to cut,the range of brain need to expose,based on pre-surgical evaluation as well as the above mentioned information.During the surgery,the 3D information guided the surgeons to dynamically adjust the surgery actions,avoiding important vessels and brain regions.Results Surgical bleeding were within 160-250 ml.Bridging vein and sinus of cerebral were not injured.All patients showed quick postoperative recovery with no anemia.All were rated as grade I (Engel).Conclusion The cerebral stratified reconstruction method and the intraoperative identification of brain gyri and sulci can greatly facilitate the surgical planning of the neurosurgeons,achieving 3D imaging for brain surgeries,and therefore enhancing the safety,accuracy,minimal invasiveness of brain surgeries and finally a digital information platform for neurosurgery.

目的 探讨SEEG引导下射频热凝致痫灶治疗药物难治性癫痫的有效性及安全性.方法 选择18例需行SEEG电极植入术行致痫灶切除术前评估的患者,根据颅内脑电监测结果,对可疑致痫灶进行热凝,热凝后继续监测脑电变化,必要时可多次热凝.拔出电极后复查头部MRI,观察热凝后影像改变.结果 18例患者毁损靶点4～16个,靶点分布于1～6根电极,热凝次数1～3次.随访期1～4个月,热凝后Engel Ⅰ级患者占44.4％(8/18),Engel Ⅲ级患者占5.6％(1/18),Engel Ⅳ级50％(9/18),总体有效率(发作减少≥75％)50％(9/18).热凝后无颅内出血、神经功能受损等并发症.结论 SEEG引导下射频热凝是一种安全有效的微创治疗癫痫方法,值得临床推广和应用.

Objective To explore the curative effects of vagus nerve stimulation ( VNS ) on intractable epilepsy .Methods The clinical data of 25 patients with intractable epilepsy , who were treated by VNS in our center from November 2009 to July 2016, were analyzed retrospectively . Results The follow up from 4 months to7 years showed that of 25 patients, 6(24%) belonged in MCHugh grade Ⅰ, 12(48%) in gradeⅡ, 4(16%) in gradeⅢand 3(12%) in grades Ⅳ~Ⅴ. Conclusions VNS is a safe and effective method to treat the intractable epilepsy .VNS may make seizure frequency reduce over 50% in more than 60% patients with intractable epilepsy .The present results suggested that the curative effect is correlated with the stimulation parameter and duration.