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中华临床医师杂志(电子版)

中华临床医师杂志(电子版) ›› 2021, Vol. 15 ›› Issue (08) : 584 -590. doi: 10.3877/cma.j.issn.1674-0785.2021.08.005

儿童癫痫·临床研究

立体定向脑电图在儿童致痫性下丘脑错构瘤中的应用
冯韬1, 卢超1, 孟飞1, 王逸鹤1, 张华强1, 魏鹏虎1, 单永治1, 赵国光1,†()   
  1. 1. 100053　北京，首都医科大学宣武医院神经外科
  • 收稿日期:2021-05-12 出版日期:2021-08-15
  • 通信作者: 赵国光
  • 基金资助:
    国家自然科学基金委重点项目(82030037)

Application of stereoelectroencephalogram in children with epileptogenic hypothalamic hamartoma

Tao Feng1, Chao Lu1, Fei Meng1, Yihe Wang1, Huaqiang Zhang1, Penghu Wei1, Yongzhi Shan1, Guoguang Zhao1,†()   

  1. 1. Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
  • Received:2021-05-12 Published:2021-08-15
  • Corresponding author: Guoguang Zhao
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引用本文：

冯韬, 卢超, 孟飞, 王逸鹤, 张华强, 魏鹏虎, 单永治, 赵国光. 立体定向脑电图在儿童致痫性下丘脑错构瘤中的应用[J]. 中华临床医师杂志(电子版), 2021, 15(08): 584-590.

Tao Feng, Chao Lu, Fei Meng, Yihe Wang, Huaqiang Zhang, Penghu Wei, Yongzhi Shan, Guoguang Zhao. Application of stereoelectroencephalogram in children with epileptogenic hypothalamic hamartoma[J]. Chinese Journal of Clinicians(Electronic Edition), 2021, 15(08): 584-590.

目的

初步探讨立体定向脑电图（SEEG）技术在儿童下丘脑错构瘤所致癫痫治疗中的作用。

方法

回顾性分析2015年7月至2019年3月首都医科大学宣武医院神经外科收治的17例下丘脑错构瘤继发癫痫患儿的临床资料。所有的患儿均行SEEG检查及SEEG引导下射频热凝治疗。采用Engel分级评估患儿术后的疗效。

结果

17例患儿共植入62根电极，每例植入1~6根电极，平均（3.6±1.4）根。随访时间为24~68个月，平均（33.9±11.6）个月。术后9例患儿癫痫得到完全控制（EngelⅠ级），5例术后发作部分改善（Engel Ⅲ级），3例患儿经射频热凝治疗后癫痫无明显改善（Engel Ⅳ级）。所有病例均未发生永久性神经功能缺损。

结论

SEEG引导射频热凝毁损术是儿童下丘脑错构瘤继发癫痫安全、有效的治疗方式。

关键词: 下丘脑错构瘤, 立体定向脑电图, 儿童, 神经外科手术, 射频热凝
Objective

To explore the values of stereoelectroencephalogram (SEEG) in the treatment of epilepsy caused by hypothalamic hamartoma in children.

Methods

The clinical data of 17 children with epilepsy secondary to hypothalamic hamartoma admitted to the Department of Neurosurgery, Xuanwu Hospital, Capital Medical University from July 2015 to March 2019 were retrospectively analyzed. All patients underwent SEEG examination and SEEG-guided radiofrequency thermocoagulation. Engel classification was used to evaluate the postoperative efficacy.

Results

A total of 62 electrodes were implanted in 17 patients, and 1 to 6 electrodes were implanted in each patient, with an average of (3.9±1.4) electrodes per patient. The postoperative follow-up time was 24 to 68 months, with an average of (33.9±11.6) months. Epilepsy was completely controlled in nine cases (Engel Ⅰ), partial improvement was achieved in five cases (Engel Ⅲ), and there was no significant improvement in three cases (Engel Ⅳ) after radiofrequency thermocoagulation. No permanent neurological deficit was found.

Conclusion

SEEG-guided radiofrequency thermocoagulation is a safe and effective treatment for epilepsy secondary to hypothalamic hamartoma in children.

Key words: Hypothalamic hamartoma, Stereoelectroencephalogram, Child, Neurosurgical procedures, Radiofrequency thermocoagulation
图1 HH患儿术前术后影像学、SEEG植入脑电图及三维重建电极情况。患儿，男，6岁，右利手，2岁起病，临床表现为发作性痴笑，偶伴有愣神发作，MRI检查可见下丘脑区一团块状肿物，考虑为HH。图a~c为MRI上可见下丘脑区团块状高密度影，其中图a、b、c分别为轴位、冠状位及矢状位；图d为SEEG植入术后发作早期脑电图，可见典型的起始部巨大的直流电漂移后叠加γ频段的低波幅快节律；图e~g为SEEG植入计划，其中图e、f、g分别为轴位、冠状位及矢状位；图h~j为术后根据患者术前MRI及植入术后复查CT三维重建电极；图k为SEEG引导下射频消融术后复查CT，可见HH病灶区低密度影注：HH为下丘脑错构瘤；SEEG为立体定向脑电图
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