Hong Seung Bong, Joo Eun Yeon, Tae Woo Suk, Cho Jae-Wook, Lee Ji-Hyun, Seo Dae Won, Suh Yeon-Lim, Hong Seung Chyul
Department of Neurology, Samsung Medical Center, SBRI, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, South Korea.
Seizure. 2008 Jun;17(4):383-6. doi: 10.1016/j.seizure.2007.07.014. Epub 2007 Sep 4.
A 27-year-old man had complex partial seizures and a dysembryoplastic neuroepithelial tumor (DNT) in the left inferior-basal temporal region. The patient's seizures consisted of incomprehensible speech, staring, unresponsiveness, fumbling and then looking around. For the brain SPECT study, radiotracer was injected during the preictal (11s prior to seizure onset), ictal (at 25 s out of 47 s seizure duration) and interictal periods. Interictal SPECT was subtracted from preictal or ictal-injection SPECTs and then the subtracted SPECTs were overlaid on the patient's MRI (SISCOM). SISCOM with preictal-injection SPECT showed hyperperfusion at the brain lesion, whereas SISCOM with ictal-injection SPECT showed hyperperfusion at the ipsilateral amygdala-hippocampus and hypoperfusion around the tumor lesion. After the DNT and nearby temporal lobe tissues were resected with preservation of amygdala-hippocampus, the patient became seizure free without complaint of subjective postsurgical memory decline. In this patient, SISCOM with preictal injection of radiotracer localized an epileptogenic zone, whereas SISCOM with the ictal injection showed hyperperfusion at the symptomatogenic zone.
一名27岁男性患有复杂部分性癫痫，左侧颞叶下基底区域存在胚胎发育不良性神经上皮肿瘤（DNT）。患者的癫痫发作表现为言语不清、凝视、无反应、摸索动作，随后环顾四周。在进行脑单光子发射计算机断层扫描（SPECT）研究时，在发作前期（发作开始前11秒）、发作期（47秒发作持续时间中的25秒）和发作间期注射放射性示踪剂。将发作间期SPECT从发作前期或发作期注射SPECT中减去，然后将相减后的SPECT叠加在患者的磁共振成像（MRI）上（发作期单光子发射计算机断层扫描减影与磁共振成像融合技术，SISCOM）。发作前期注射SPECT的SISCOM显示脑病变处血流灌注增加；而发作期注射SPECT的SISCOM显示同侧杏仁核 - 海马血流灌注增加，肿瘤病变周围血流灌注减少。在保留杏仁核 - 海马的情况下切除DNT及附近颞叶组织后，患者癫痫发作停止，且无主观术后记忆减退的主诉。在该患者中，发作前期注射放射性示踪剂的SISCOM定位了癫痫发作起始区，而发作期注射的SISCOM显示症状起始区血流灌注增加。
