Smith J R, King D W, Park Y D, Lee M R, Lee G P, Jenkins P D
Department of Neurology, Medical College of Georgia, Augusta 30912, USA.
J Neurosurg. 2000 Dec;93 Suppl 3:136-40. doi: 10.3171/jns.2000.93.supplement.
The purpose of this study was to determine if magnetic source (MS) imaging could provide useful information in the planning and performance of gamma knife radiosurgery (GKS) for epilepsy.
Magnetic source imaging of interictal epileptiform dipoles was studied in 53 epilepsy surgery candidates. All patients underwent volumetric magnetic resonance (MR) imaging. Subsequently, magnetoencephalography (MEG) was performed using single or dual 37-channel units. The MR images and MEG recordings were then coregistered to produce the MS imaging data. Magnetic source imaging epileptiform data were reviewed in a blinded fashion and spatial distributions were classified as focal, regional, multiple, scattered, or none. Postresection operative photographs were compared with MS image results to determine whether extensive or partial/no resection of the MS image focus had been accomplished. Magnetoencephalography dipoles were identified in 47 patients (89%), in 46 of whom the lesions were resected. This included 20 (80%) of 25 anterior temporal lobe (ATL) cases, and 26 (93%) of 28 extratemporal lobe (ETL) cases. Of the six patients who underwent extensive ATL resections, three (50%) were seizure free. Of 14 patients who underwent partial/no resection of the ATL, seven (50%) were seizure free. There was no clear relation between MS image spatial distribution and surgery-related outcome. Of the seven ATL cases with hippocampal atrophy, five patients (71%) were seizure free. Of 12 ETL cases (three lesional), 10 patients (83%) were seizure free. Of 14 patients who underwent partial/no ETL resections (three lesional), two (14%) were seizure free. Of five nonlesional ETL cases with focal MS image dipoles, four patients (80%) were seizure free. Of five nonlesional ETL cases with regional dipoles, three patients (60%) were seizure free. Of eight ETL cases with multiple MS image dipoles, two patients (25%) were seizure free. Spatial agreement of MS imaging and electrographic data had no apparent effect on outcome of either ATL or ETL cases.
Nonlesional ETL cases with focal (and in some cases multiple or regional) epileptiform MS image dipole distributions benefit significantly from inclusion of the MS image epileptiform focus in the resections. Nonlesional ETL cases suitable for GKS may similarly benefit from including the MS image focus in the irradiated area.
本研究旨在确定磁源（MS）成像能否为癫痫的伽玛刀放射外科治疗（GKS）的规划和实施提供有用信息。
对53例拟行癫痫手术的患者进行发作间期癫痫样偶极子的磁源成像研究。所有患者均接受容积磁共振（MR）成像。随后，使用单通道或双通道37导装置进行脑磁图（MEG）检查。然后将MR图像和MEG记录进行配准以生成MS成像数据。以盲法审查磁源成像癫痫样数据，并将空间分布分类为局灶性、区域性、多发性、散在性或无。将术后手术照片与MS图像结果进行比较，以确定是否已完成MS图像病灶的广泛切除或部分/未切除。在47例患者（89%）中识别出脑磁图偶极子，其中46例患者的病灶被切除。这包括25例颞叶前内侧（ATL）病例中的20例（80%），以及28例颞叶外（ETL）病例中的26例（93%）。在6例行广泛ATL切除的患者中，3例（50%）无癫痫发作。在14例行ATL部分/未切除的患者中，7例（50%）无癫痫发作。MS图像空间分布与手术相关结果之间无明确关系。在7例有海马萎缩的ATL病例中，5例患者（71%）无癫痫发作。在12例ETL病例（3例有病灶）中，10例患者（83%）无癫痫发作。在14例行ETL部分/未切除的患者（3例有病灶）中，2例（14%）无癫痫发作。在5例有局灶性MS图像偶极子的非病灶性ETL病例中，4例患者（80%）无癫痫发作。在5例有区域性偶极子的非病灶性ETL病例中，3例患者（60%）无癫痫发作。在8例有多个MS图像偶极子的ETL病例中，2例患者（25%）无癫痫发作。MS成像与电图数据的空间一致性对ATL或ETL病例的结果均无明显影响。
具有局灶性（在某些情况下为多发性或区域性）癫痫样MS图像偶极子分布的非病灶性ETL病例，将MS图像癫痫样病灶纳入切除范围可显著获益。适合GKS的非病灶性ETL病例，将MS图像病灶纳入照射区域可能同样获益。
