Karataş Ayşe, Erdem Atilla, Savaş Ali, Kutlu Gülnihal, Yağmurlu Banu, Erden Ilhan, Bilir Erhan
Department of Neurosurgery, Ankara University School of Medicine, Ibni Sina Hastanesi-Beyin, Cerrahisi Kliniği, Ankara, Turkey.
J Clin Neurosci. 2004 Apr;11(3):343-6. doi: 10.1016/j.jocn.2003.03.005.
Cases with intractable epilepsy may present with multiple lesions in their brains. Ictal-EEG carries a great value in identification of the primary epileptogenic source. On the other hand, removal of low-grade tumors located around the eloquent cortex may be risky with conventional techniques. Functional-neuronavigation (f-NN) is the integration of functional magnetic resonance imaging and stereotactic technologies; and provides interactive data regarding localization of the motor cortex. This report presents a case with dysembryoplastic neuroepithelial tumor (DNET), which was removed using f-NN and electrocorticography (ECoG) techniques.
A 19-year-old patient with intractable complex partial and secondary generalized seizures is presented. MRI revealed a low-grade tumor located in right parietal region just behind the motor cortex, and a contralateral temporal arachnoid cyst. Ictal-EEG demonstrated the right parietal origin of the seizures. The patient underwent a right parietal craniotomy and tumor excision using f-NN and ECoG techniques intraoperatively. ECoG findings correlated with epileptogenicity of the parietal lesion.
Postoperative course was uneventful. No postoperative deficit was observed. The patient was seizure free in eight months follow-up. Pathological examination reported the lesion as DNET.
Ictal-EEG has a very important role in identification of the epileptogenic focus in cases with multiple brain lesions. Preservation of the functional cortex is the most prominent aim during lesional surgery of epilepsy. Intraoperative mapping using f-NN and ECoG supports the orientation of the neurosurgeon to the functional and epileptogenic cortical areas; and thus, increase the safety and efficacy of surgical procedures.
难治性癫痫患者的脑部可能存在多个病灶。发作期脑电图在确定原发性致痫源方面具有重要价值。另一方面，采用传统技术切除位于功能区皮质周围的低级别肿瘤可能具有风险。功能神经导航（f-NN）是功能磁共振成像和立体定向技术的结合，可提供有关运动皮质定位的交互式数据。本报告介绍了一例使用f-NN和皮质脑电图（ECoG）技术切除胚胎发育不良性神经上皮肿瘤（DNET）的病例。
报告一名19岁难治性复杂部分性发作和继发性全身性发作的患者。MRI显示一个低级别肿瘤位于运动皮质后方的右侧顶叶区域，以及对侧颞部蛛网膜囊肿。发作期脑电图显示癫痫发作起源于右侧顶叶。患者接受了右侧顶叶开颅手术，并在术中使用f-NN和ECoG技术切除肿瘤。ECoG结果与顶叶病变的致痫性相关。
术后病程顺利。未观察到术后神经功能缺损。在八个月的随访中患者无癫痫发作。病理检查报告该病变为DNET。
发作期脑电图在识别多脑病灶病例的致痫灶方面具有非常重要的作用。在癫痫病灶手术中，保留功能区皮质是最主要的目标。使用f-NN和ECoG进行术中定位有助于神经外科医生明确功能区和致痫性皮质区域，从而提高手术的安全性和有效性。
