超声引导脑电监测在脑动静脉畸形继发癫痫手术中的应用

doi:10.6040/j.issn.1671-7554.0.2020.0822

摘要/Abstract

摘要： 目的探讨超声引导联合皮层脑电图(ECoG)监测在脑动静脉畸形(cAVM)继发癫痫显微手术治疗中的作用和价值。方法回顾性分析显微手术治疗的18例cAVM继发癫痫患者的临床资料,术中均采用超声引导及ECoG监测的方法指导cAVM完全切除及致痫灶切除。结果术中超声能清晰显示cAVM血管团位置、边界及cAVM的供血动脉、引流静脉情况,指导cAVM血管团完整切除,也有效发现手术残余从而指导补充切除,最终达到cAVM血管团完全切除;术中ECoG可监测到cAVM周围及其远隔部位的痫性放电,有效指导致痫灶合理化处理以减少脑功能的损伤。本组病例术后随访≥2年,无神经功能障碍,癫痫无发作,按照Engel的疗效判断标准,均为EngleⅠ级。结论术中超声引导可准确定位cAVM且能判定其供血动脉及残余情况,指导完整切除;ECoG监测确定致痫灶,进一步指导切除范围。二者联合应用能够有效减少脑组织损伤、减少手术并发症,显著提高癫痫治疗效果。

关键词: 术中超声, 皮层脑电图监测, 脑动静脉畸形, 癫痫

Abstract: Objective To explore the role and value of ultrasound-guided electrocorticography(ECoG)monitoring in the microsurgery of epilepsy secondary to cerebral arteriovenous malformations(cAVM). Methods The clinical data of 18 patients with epilepsy secondary to cAVM treated with microsurgery were retrospectively analyzed. During operation, the complete resection of cAVM and epileptogenic zone was under ultrasound guidance and ECoG monitoring. Results Intraoperative ultrasound could clearly show the position, boundary, feeding artery and drainage veins of cAVM; it could identify the surgical remnants so as to guide complete resection of cAVM vascular mass. ECoG could monitor the epileptic discharges and thus reduce injury on brain function. During the follow-up of more than 2 years, no neurological dysfunction or seizure occurred. The efficacy reached Engel I in all cases. Conclusion Intraoperative ultrasound guidance can accurately locate cAVM and determine its feeding artery and residual conditions, guide complete resection; ECoG monitoring determines epileptogenic zone, and further guides the scope of resection. Intraoperative ultrasound guidance combined with ECoG monitoring can effectively reduce complications and brain injury, and significantly improve the therapeutic effects.

Key words: Intraoperative ultrasound, Electrocorticography monitoring, Cerebral arteriovenous malformation, Epilepsy

中图分类号:

R742.1

孙永锋,刘会昭,李煜环,石磊,袁俊,钟建卫. 超声引导脑电监测在脑动静脉畸形继发癫痫手术中的应用[J]. 山东大学学报 (医学版), 2020, 58(12): 60-64.

SUN Yongfeng, LIU Huizhao, LI Yuhuan, SHI Lei, YUAN Jun, ZHONG Jianwei. Application of ultrasound-guided electrocorticography monitoring in the microsurgical treatment of epilepsy secondary to cerebral arteriovenous malformation[J]. Journal of Shandong University (Health Sciences), 2020, 58(12): 60-64.

参考文献

[1] Ollivier I, Cebula H, Todeschi J, et al. Predictive factors of epilepsy in arteriovenous malformation [J]. Neurochirurgie, 2020, 66(3): 144-149.
[2] Ditty Benjamin J, Omar Nidal B, Foreman Paul M, et al. Seizure outcomes after stereotactic radiosurgery for the treatment of cerebral arteriovenous malformations [J]. J Neurosurg, 2017, 126(3): 845-851.
[3] Takayama Mio, Hara Kenji, Matsusue Aya, et al. Giant intracranial arteriovenous malformation as the focus of epileptic seizures [J]. Neuropathology, 2018, 38(2): 185-191.
[4] 张占伟, 喻坚柏, 罗刚. 合并脑室出血的小脑幕区脑血管畸形的急诊血管内治疗(附18例报道)[J]. 中国临床神经外科杂志, 2017, 22(5): 327-329. ZHANG Zhanwei, YU Jianbo, LUO Gang. Emergency endovascular treatment of cerebellar tentorial cerebrovascular malformations complicated with intraventricular hemorrhage(report of 18 cases)[J]. Chinese Journal of Clinical Neurosurggery, 2017, 22(5): 327-329.
[5] 任伟, 汪姝. 三维DSA与MRI或CT影像融合技术要点及在颅内动静脉畸形诊治中的应用[J]. 临床研究, 2019, 27(3): 137-139. REN Wei, WANG Shu. Three-dimensional DSA and MRI or CT Image Fusion Techniques and Their Application in Diagnosis and Treatment of Intracranial Arteriovenous Malformation [J]. Clinical Research, 2019, 27(3): 137-139.
[6] 石瑞成, 赵志军, 韩建国. 脑动静脉畸形14例临床治疗体会[J]. 包头医学院学报, 2018, 34(12): 42-43. SHI Ruicheng, ZHAO Zhijun, HAN Jianguo. Treatment of 14 cases of cerebral arteriovenous malformation [J]. Journal of Baotou Medical College, 2018, 34(12): 42-43.
[7] 黄旭华, 曹杰, 何华. 介入治疗前后脑血管畸形患者MMP-2,MMP-9表达水平及意义探讨[J]. 江西医药, 2018, 53(10): 1054-1056. HUANG Xuhua, CAO Jie, HE Hua. Changes and significance of mmp-2 and mmp-9 expression in patients with cerebrovascular malformation before and after interventional therapy [J]. Jiangxi Medical Journal, 2018, 53(10): 1054-1056.
[8] Sousa EC, Teixeira MJ, Piske RL, et al. The role of preradiosurgical embolization in the management of grades Ⅲ, Ⅳ, and Ⅴ arteriovenous malformations [J]. Front Surg, 2016, 3(6): 37.
[9] Potts MB, Lau D, Abla AA, et al. Current surgical results with low- grade brain arteriovenous malformations [J]. J Neurosurg, 2015, 122(4): 912-920.
[10] 宋剑平, 朱巍. 高级别脑动静脉畸形复合手术的价值与策略[J]. 临床外科杂志, 2018, 26(7): 486-490. SONG Jianping, ZHU Wei. The value and strategy of high-grade combined surgery for cerebral arteriovenous malformations [J]. Journal of Clinical Surgery, 2018, 26(7): 486-490.
[11] 王威, 宋冬雷. 基于临床分级的颅内动静脉畸形显微外科手术治疗的风险评估[J]. 中国脑血管病杂志, 2018, 15(7): 337-339. WANG, Wei, SONG Donglei. Risk assessment of microsurgical treatment of intracranial arteriovenous malformations based on clinical grading [J]. Chinese Journal of Cerebrovascular Diseases, 2018, 15(7): 337-339.
[12] 李勇杰. 功能神经外科学[M]. 北京: 人民卫生出版社, 2018: 648.
[13] 付信飞, 卓红平, 黎俊. 分析 CT、MRI 联合在诊断颅脑动静脉畸形(AVM)的临床价值[J]. 智慧健康, 2019, 5(2): 159-160. FU Xinfei, ZHU Hongping, LI Jun. Analyzing the clinical value of combined CT and MRI in the diagnosis of craniocerebral arteriovenous malformation(AVM)[J]. Smart Healthcare, 2019, 5(2): 159-160.
[14] 张建宁. 神经外科学高级教程[M]. 北京: 人民军医出版社, 2015: 370.
[15] Huang YJ, Hsu SW, Lee TF, et al. Consistency between targets delineated by angiography, computed tomography, and magnetic resonance imaging in stereotactic radiosurgery for arteriovenous malformation [J]. Stereotact Funct Neurosurg, 2017, 95(4): 236-242.
[16] 孙立娜. 彩色多普勒超声诊断脑动静脉畸形临床价值[J]. 中国现代药物应用, 2012, 6(8): 54-55. SUN Lina. The clinical value of color Doppler ultrasonography in diagnosing cerebral arteriovenous malformation [J]. Chinese of modern Drug Application, 2012, 6(8): 54-55.
[17] 张施远, 曾春, 石海平, 等. 术中超声辅助下急诊手术切除破裂出血的大型脑动静脉畸形[J]. 中国临床神经外科杂志, 2017, 22(12): 811-814. ZHANG Shiyuan, ZENG Chun, SHI Haiping, et al. Intraoperative ultrasound-assisted emergency microsurgery for large cerebralarteriovenous malformations with hemorrhage [J]. Chinese Journal of Clinical Neurosurgery, 2017, 22(12): 811-814.
[18] 刘会昭, 王松涛, 贾维广, 等. 常规超声在颅脑占位性病变切除术中的应用[J]. 武警医学, 2012, 23(12): 1083-1085. LIU Huizhao, WANG Songtao, JIA Weiguang. The application of conventional ultrasound in the resection of brain space occupying lesions [J]. Medical Journal of the Chinese People's Armed Police Forces, 2012, 23(12): 1083-1085.
[19] Monteith Stephen, Snell John, Eames Mathew, et al. Transcranial magnetic resonance-guided focused ultrasound for temporal lobe epilepsy: a laboratory feasibility study [J]. J Neurosurg, 2016, 125(6): 1557-1564.
[20] 姜笑千, 何文, 赵继宗, 等. 颅内动静脉畸形的术中超声应用研究[J]. 中华医学超声杂志(电子版), 2006, 3(4): 213-215. JIANG Xiaoqian, HE Wen, ZHAO Jizong, et al. Application of intraoperative ultrasound in the surgical treatment of arteriovenous malformations [J]. Chinese Journal of medical ultrasound(Electronic Edition), 2006, 3(4): 213-215.
[21] 姚文华, 张德明, 朱成明, 等. 彩色多普勒超声在颅内动静脉畸形切除术中的应用[J]. 华西医学, 2011, 26(6): 896-899. YAO Wenhua, ZHANG Deming, ZHU Chengming, et al. Application of Intraoperative Ultrasonography In The Resection Of Intracranial Arteriovenous Malformation [J]. West China Medical Journal, 2011, 26(6): 896-899.
[22] 张晓峰, 零达尚, 林其炎, 等. 急诊显微手术治疗在42例颅内动静脉畸形破裂出血患者中的应用体会[J]. 贵州医药, 2018, 42(5): 63-64. ZHANG Xiaofeng, LING Dashang, LIN Qiyan, et al. The application of emergency microsurgery in 42 patients with intracranial arteriovenous malformation and hemorrhage [J]. Guizhou Medical Journal, 2018, 42(5): 63-64.
[23] Shakur Sophia F, Brunozzi Denise, Ismail Rahim, et al. Effect of Age on Cerebral Arteriovenous Malformation Draining Vein Stenosis [J]. World Neurosurg, 2018, 113(5): e654-e658.
[24] 孙永锋, 刘会昭, 钟建卫, 等. 超声引导电生理监测下手术治疗儿童海绵状血管瘤继发癫痫6例[J]. 山东大学学报(医学版), 2016, 54(4): 55-59. SUN Yongfeng, LIU Huizhao, ZHONG Jianwei, et al. Ultrasound guidance and electrophysiological monitoring in microsurgical treatment of 6 cases of cavernous hemangioma in children with secondary epilepsy [J]. Journal of Shandong University(Health Sciences), 2016, 54(4): 55-59.
[25] Trujillo LT, Stanfield CT, Vela RD. The effect of electroencephalogram(EEG)reference choice on information-theoretic measures of the complexity and integration of EEG signals [J]. Front Neurosci, 2017, 11(7): 425.

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