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目的探讨正电子发射断层扫描(PET)对难治性癫痫的定位价值,评价γ-刀治疗难治性癫痫的效果及脑电图改变。方法43例患者主要依据PET显像,结合癫痫发作特点、EEG、MRI等检查综合定位致痫灶,应用MASEP-SRRS型旋转式γ-刀治疗,单纯性致痫灶照射边缘剂量为9～14Gy,等中心曲线40%～60%。需加照射杏仁核和海马时,边缘剂量25～30Gy;照射胼胝体时中心剂量75～100Gy,均为50%等剂量曲线。随访3～36个月,观察发作频率、脑电图变化情况,评价治疗效果。结果43例患者中,39例(90.7%)为发作间期的PET图像,表现皮层局限性低代谢灶,其中单发灶33例(84.6%),多发灶6例(15.4%);4例(9.3%)为发作期的PET图像,表现皮层单发的局限性高代谢灶;异常代谢灶常见于颞叶,其次为额叶。发作频率术前5.2±2.6次/月,术后12个月降至1.3±0.9次/月,随访结束时降至0.9次/月左右,与治疗前相比差异具有显著性意义(P<0.01)。对随访6～36个月的病人进行Wieser疗效评定,Ⅰ～Ⅱ级为31.4%～38.9%,Ⅲ～Ⅳ级为43.6%～51.4%,Ⅴ～Ⅵ级为15.3%～23.1%,其中Ⅰ～Ⅳ级(有效率)为76.9%～84.6%。EEG逐渐恢复正常为7.7%～16.7%,53.8%～62.9%好转,22.2%～38.5%无变化,好转率61.5%～77.8%。主要并发症为放射性脑水肿,发生率为16.7%,经对症治疗后均能缓解。结论PET辅助定位下,低剂量γ-刀治疗顽固性癫痫具有较高的有效率,无严重并发症,是一种有效的癫痫微侵袭外科治疗方法;采用9～14Gy的周边剂量照射PET提示的致痫灶可取得良好效果。
Objective To investigate the value of positron emission tomography (PET) in the treatment of intractable epilepsy and to evaluate the effect of γ-knife in the treatment of refractory epilepsy and the changes of electroencephalogram. Methods 43 patients were mainly based on PET imaging, combined with the characteristics of seizures, EEG, MRI and other tests to locate the epileptogenic focus, the application of MASEP-SRRS rotary γ-knife treatment, simple epileptogenic edge irradiation dose of 9 ~ 14Gy , Such as the center curve of 40% to 60%. When irradiation with amygdala and hippocampus is required, the marginal dose is 25-30 Gy; when the corpus callosum is irradiated, the central dose is 75-100 Gy, which is equal to 50% of the dose curve. Followed up for 3 to 36 months, observed the frequency of seizures, EEG changes, evaluate the therapeutic effect. Results Of the 43 patients, 39 (90.7%) were interictal PET images showing low-grade cortical lesions with 33 lesions (84.6%) and 6 lesions (15.4%) in 4 lesions (9.3%) were PET images of the seizure stage, showing the limitations of cortical solitary high metabolic focus; abnormal metabolic lesions common in the temporal lobe, followed by the frontal lobe. The frequency of seizure was 5.2 ± 2.6 times per month before surgery, 1.3 ± 0.9 times per month after 12 months, 0.9 times per month at the end of follow-up, and the difference was significant (P <0.01) ). The Wieser curative effect was evaluated in patients who were followed up for 6 to 36 months. The grade Ⅰ ~ Ⅱ was 31.4% ~ 38.9%, the grade Ⅲ ~ Ⅳ was 43.6% ~ 51.4%, the grade Ⅴ ~ Ⅵ was 15.3% ~ 23.1% Grade Ⅳ (effective rate) was 76.9% ~ 84.6%. EEG gradually returned to normal 7.7% ~ 16.7%, 53.8% ~ 62.9% improved, 22.2% ~ 38.5% no change, improvement rate of 61.5% ~ 77.8%. The main complication is radiation brain edema, the incidence was 16.7%, after symptomatic treatment can relieve. Conclusion PET-assisted localization of low-dose γ-knife treatment of refractory epilepsy with high efficiency, no serious complications, is an effective surgical treatment of epilepsy micro-invasion; the use of peripheral dose of 9 ~ 14Gy PET prompted Epileptogenic lesions can achieve good results.