简体中文

论著-头颈部

CE-MRV融合颅脑三 维成像在儿童难治 性癫痫外科中的应 用

作者:向 葵1 刘龙平1 朱凤军2 孟宪磊1

所属单位:1.深圳市儿童医院放射科 (广东 深圳 518038) 2.深圳市儿童医院神经外科 (广东 深圳 518038)

PDF

摘要

目的 利用磁共振颅脑三维(3DMRI)及增强静脉成像(CE-MRV)导入神经 导航系统获取患者脑表面血管三维立体 脑电图,用以精确定位颅内致痫灶并指导 外科手术治疗,观察其在儿童药物难治性 癫痫患儿治疗中的准确性、安全性及有效 性。方法 我院神经外科2016年3月至2017 年10月收治的22例药物难治性癫痫患者行 颅脑3D-MRI及CE-MRV,利用 StealthViz? 神经导航系统融合影像数据,进行脑组织 分割,建立立体大脑及皮层静脉模型,设 计路径避开血管,在该立体定向系统下植 入电极,术后长程视频脑电监测颅内致痫 灶,并对有手术指征患者进行手术切除, 术后对患者进行随访,分析其准确性、安 全性及有效性。结果 22例患者三维立体 图像效果均较好,皮层静脉均显示清楚, 手术所有电极均成功植入,共植入电极 143枚,所有患儿均未出现出血及感染等 并发症,出血发生率0%,其中一例行二 次手术补置电极一根,亦无并发症发生。 所有病例术后进行视频脑电监测,确定颅 内致痫灶并进行手术,术后随访疗效满 意。结论 应用磁共振颅脑3D-MRI及CEMRV成像建立立体大脑及皮层静脉模型能 有效避免电极植入出血;立体定向电极植 入作为儿童药物治疗难治性癫痫的方法是 准确、安全、有效的。

Objective To observe the accuracy, safety and efficacy of pinpointing intracranial epileptogenic lesions and guiding surgical treatment of children with refractory epilepsy by using 3D-MRI of cranial brain and venous MRI with contrast enhancement (CE-MRV) into the neural navigation system to form three-dimensional stereoelectroencephalography (SEEG). Methods 22 cases of refractory epilepsy from Mar 2016 to Oct 2017 in our hospital underwent cranial brain 3D-MRI and CE-MRV, which input in StealthViz® neural navigation system to establish stereotactic 3D brain and cortical vein model. Electrodes were implanted and all the brain surface vessels were avoided because of well-designed surgical path under this system. SEEG operations were performed on all patients with surgical indications after intracranial epileptogenic lesions were monitored by long-term video EEG. All patients were followed up after operation to analyze their accuracy, safety and effectiveness. Results 3D-MRI and CE-MRV images of 22 patients were shown clearly, all the electrodes were successfully implanted, A total of 143 electrodes were implanted, none of the cases had complications of bleeding and infection, and the incidence of bleeding was 0%, only one of them was implanted with an electrode in a second operation, and no complications occurred as well. All patients intracranial epileptogenic lesions were localized and removed after monitored by video EEG. Followup effect in all patients were satisfactory. Conclusion Using 3D-MRI of cranial brain and CE-MRV to establish stereoscopic cerebral and cortical venous model can effectively prevent electrode implantation bleeding; SEEG implantation as an invasive method of pre-operation evaluation in refractory epilepsy patients of children is accurate, safe and effective.

【关键词】磁共振成像;增强静脉成像; 神经导航系统;难治性癫痫

【中图分类号】R742.1;R445.2

【文献标识码】A

【DOI】 10.3969/j.issn.1672- 5131.2019.04.005

前言

目前全世界约有1050万癫痫患病儿童,约20%患儿无法用现有抗癫 痫药物控制癫痫的发作,称作难治性癫痫[1]。目前癫痫外科手术治疗是 惟一可以治愈难治性癫痫的手段, 精确定位颅内致痫灶是进行外科手 术的前提,也是决定患者预后最重要因素。立体定向脑电图(stereoelectroencephhalography,SEEG)是集解剖-电-临床为一体的立体脑 电图理念,探寻、定位致痫区的方法,高分辨影像学及机器人立体定 向的出现极大地促进SEEG方法学的革新[2],利用磁共振颅脑三维(3DMRI)成像及增强静脉成像(CE-MRV)导入神经导航系统建立立体大脑及 皮层静脉融合模型图,有助于精确定位指导电极植入并减少创伤。我 院神经外科自2015年以来应用神经导航结合立体定向技术已对22例患 儿植入电极并对癫痫灶进行了手术切除,现介绍CE-MRV融合颅脑三维 成像在儿童难治性癫痫外科电极植入的应用。