Objective:To explore the efficacy and safety of conformal radiofrequency thermocoagulation (RF-TC) guided by stereo-electroencephalography (SEEG) based on three-dimensional images for the treatment of epilepsy caused by focal cortical dysplasia (FCD).Methods:A retrospective study was conducted on the clinical data of 19 patients with drug-refractory epilepsy admitted to the Epilepsy Centre of Guangdong Sanjiu Brain Hospital from September 2017 to December 2019. The lesion in all patients was confirmed to be FCD and had clear boundaries based on preoperative evaluation including imaging and electroencephalography. The maximum diameter of lesions ranged from 1.4 cm to 4.0 cm with an average of 2.3±0.7 cm. All patients underwent SEEG electrode placement. During the design of electrode placement scheme, the software of 3D-Slicer was used to reconstruct the three-dimensional MRI images and the lesions were tried to be covered by the SEEG electrode contacts as much as possible. RF-TC was performed to ablate the lesion. Regular follow-up was performed post operation. The modified Engel classification was used to evaluate the outcome of seizure control.Results:In 19 patients, 9±2 SEEG electrodes/case (6-12 electrodes/case) were implanted, and the number of electrodes passing through the lesion was 5±2/case (2-8/case). The RF-TC target points during treatment were 25±13/case (6-52/case), and RF-TC was completed in 1 to 4 times/case. Eight patients experienced temporary muscle strength decline after operation, but all recovered completely before being discharged from the hospital. All 19 patients were followed up for 17±8 months (6-33 months). At the last follow-up, there were 16 cases classified as grade Ⅰ, 2 cases as grade Ⅱ, and 1 case as grade Ⅲ based on the modified Engel classification. None of the patients had permanent neurological deficits.Conclusion:For patients with drug-refractory epilepsy caused by FCD with established epileptogenicity, clear boundaries and limited scope, the SEEG-guided conformal thermocoagulation based on three-dimensional imaging has few complications and a good prognosis.

目的 研究颞叶外节细胞胶质瘤(GG)继发癫痫的临床特点和手术治疗方式及疗效.方法 回顾性分析手术治疗并经病理证实的20例颞叶外节细胞胶质瘤继发癫痫患者的临床资料.术后癫痫控制效果按改良Engel分级标准评定;分析患者的发作表现、病变部位、影像学特点、病理改变、手术方式及病变切除程度与癫痫控制的关系.结果 节细胞胶质瘤位于额叶者2例、顶叶7例、枕叶5例、颞枕交界处6例.MRI检查显示肿瘤为囊性者5例、囊实性6例、实性9例;增强扫描病变有强化12例,病变周围水肿5例.CT检查示病变有钙化4例.癫痫发作表现为简单部分性发作(伴意识保留的局灶性发作)者4例,复杂部分性发作(伴意识障碍的局灶性发作)5例,继发性全面性强直阵挛(局灶进展到双侧的强直阵挛发作)11例.肿瘤次全切除者2例,全切除15例,扩大切除3例.术后病理检查示合并脑皮质发育不良者2例.术后随访1～3年,癫痫控制效果为Engel Ⅰ级17例(85.0％),Ⅱ级2例(10.0％),Ⅲ级1例(5.0％).预后相关临床因素分析显示,肿瘤切除的方式和程度与预后有关.结论 颞叶外节细胞胶质瘤继发癫痫多为药物难治性,手术切除可取得良好效果.术前须综合评估病变部位和临床、影像学特点等资料制定手术策略,术中尽可能行肿瘤加致痫皮层全切除,以提高疗效.必要时可考虑先行SEEG电极植入后,再行致痫灶精准切除术.

目的 探讨胚胎发育不良性神经上皮肿瘤(DNT)继发癫痫的临床特点和手术疗效.方法 回顾性分析2014年12月至2019年1月手术治疗并经病理证实的53例DNT合并癫痫的临床资料.结果 肿瘤次全切除9例,全切除23例,扩大切除21例.术后病理检查结果均为DNT,其中合并局灶性脑皮质发育不良20例、海马硬化4例、神经节细胞胶质瘤4例.术后随访1～3年,Engel分级Ⅰ级43例(81.1％;其中MRI分型Ⅰ型29例,Ⅱ型11例,Ⅲ型3例),Ⅱ级4例(7.5％),Ⅲ级4例(7.5％),Ⅳ级2例(3.8％);术后复查MRI未见肿瘤复发或进展.结论 DNT继发癫痫多为药物难治性癫痫,手术切除可取得良好效果.术前需综合评估病变部位和影像学特点等制定相应的手术方案,术中尽可能全切肿瘤,有助于提高手术疗效.