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- Role of Foramen Ovale Electrodes in Presurgical Evaluation of Intractable Complex Partial Seizures
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題 名 | Role of Foramen Ovale Electrodes in Presurgical Evaluation of Intractable Complex Partial Seizures=卵圓孔電極於頑性癲癇病患術診斷之應用 |
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作 者 | 施養性; 姚俊興; 黃俊一; | 書刊名 | 中華醫學雜誌 |
卷 期 | 60:3 1997.09[民86.09] |
頁 次 | 頁155-160 |
分類號 | 416.29 |
關鍵詞 | 頑性癲癇; 卵圓孔電極; 前顳葉切除術; Anterior temporal lobectomy; Foramen ovale electrodes; Intractable complex partial seizures; |
語 文 | 英文(English) |
中文摘要 | 背景:顱內電極如腦血深部電極,硬腦膜下電極板,於頑性癲癇病患之術前診斷具有準確之定位價值。然其技術上較為困難,且危險性較高。Wieser等人於1984年首先報告以卵圓孔電極來定位顳葉癲癇病患之致癇病灶。 方法:自1993年10月起,我們為12位頑性癲癇病患植入兩側之卵圓孔電極,進行癲癇手術之術前診斷。其中9位病患之顱外腦波顯示其致癇病灶源於兩側之顳葉內側;一位病患之磁振造影顯示一蜘蛛網膜腔囊腫位於右側前顳葉,然其顱外腦波顯示其致癇病灶源於左側之顳葉內側;一位病患之致癇病灶源於左側之前顳葉,而其左側內頸動脈之巴比妥鈉鹽測試顯示記憶力缺損;另一位病患之致癇病灶源於左側之前顳葉,而其正子斷層掃描顯示右側前顳葉之葡萄糖代謝降低。 結果:經過長時間腦波影像同步監錄後,共9位病患接受了前顳葉切術。其中有7位病患之卵圓孔電極腦波清楚顯示其致癇腦波異常實際上源於單側之顳葉內側。 而另2位病患係根據其卵圓孔電極發作間歇期腦波異常及磁振造影和正子斷層掃描之結果決定切除部位。7位(78%)術後癲癇完全不再發作。 未接受手術之病患中,兩位之卵圓孔電極腦波顯示多發性致癇病灶;另一位則有兩側顳葉之致癇病灶。本系列之卵圓孔電極植入術,並無嚴重之併發症。 結論:卵圓孔電極植入術是一種半侵入性癲癇手術之術前診斷技巧。其最恰當之適應症為顱腦波顯示其致癇病灶源於兩側之顳葉內側者。此技術安全性高且其致癇病灶定位準確,可作為腦內深部電極及硬腦膜下電極板之替代方法。 |
英文摘要 | Background: The value of intracranial electrodes such as depth electrodes and subdural grids for intracranial electroencephaloraphic (EEG) recording in patients with intractable epilepsies has been well recognized. A new technique, foramen ovale electrode (FOE) implantation, was first introduced by Wieser in 1984 for the lateralization of bilateral mesiotemporal lobe (MTL) onset of seizures. Methods: Since October 1993, a multipolar, three-contact FOE has been used in 12 intractable epileptic patients for presurgical evaluation. The reasons for FOE implantation included bilateral MTL onset of seizures recorded by extracranial EEGs in nine patients, and extracranial EEG abnormalities inconsistent with the results of magnetic resonance imaging (MRI), positron emission tomogram (PET) or Wada test in three patients. Under general anesthesia, the FOEs were implanted according to the technique introduced by Kirschner, using Barters landmarks. Results: After long-term telemetry recording with FOE, seven patients revealed clear onset of seizures originating from one side of the MTL and underwent anterior temporal lobectomy (ATL). Two patients had seizures of bilateral MTL onset. However, they received ATL due to predominantly unilateral interictal epileptiform discharges (EDs) and/or MRI and PET abnormalities. Seven (78%) of the nine operated patients became seizure-free after ATL. Three patients were considered not operable because two had multifocal onset of seizures and one had seizures with independent bilateral MTL onset. No serious complication resulted from implantation of FOE in this series. Conclusions: The semi-invasive techniique of FOE is reliable for lateralization of bilateral MTL onset of seizures which are often not clearly recorded by extracranial EEGs. This procedure is safe and can be an alternative to invasive implantation of depth electrodes and subdural grids. |
本系統中英文摘要資訊取自各篇刊載內容。