Markand O N, Salanova V, Worth R M, Park H M, Wellman H H
Department of Neurology, Indiana University School of Medicine, Indianapolis.
Acta Neurol Scand Suppl. 1994;152:137-44. doi: 10.1111/j.1600-0404.1994.tb05206.x.
At the Indiana University Medical Center, 99 patients with medically intractable complex partial seizures (MI-CPS) had presurgical evaluation with subsequent anterior temporal lobectomy. The majority of the patients had single photon emission tomography (SPECT) performed interictally as well as during an actual epileptic seizure (ictal scan). Decreased regional cerebral perfusion (rCP) was seen in 54/94 (57%) of the interictal scans corresponding to the eventual site of the surgery. However, ictal scans provided a higher yield; increased rCP in the temporal lobe during an actual seizure was observed in 60/82 (73%) concordant to the side of surgery. SPECT is a useful, noninvasive method of localizing the epileptiform focus in patients with MI-CPS considered for resective surgery. Both interictal and ictal SPECT need to be performed; combined interictal hypoperfusion and ictal hyperperfusion in the same focal area are unique to epileptogenic lesions. Ictal SPECT studies can be performed in the majority of patients during the period of continuous video/EEG monitoring with only a little additional effort. Combining the results of functional brain imaging (interictal and ictal SPECT, PET) with clinical semiology of seizures, surface and sphenoidal EEG, magnetic resonance imaging and other non-invasive tests, anterior temporal lobectomy can be recommended in approximately two-thirds of the patients without resorting to potentially dangerous intracranial EEG monitoring.
在印第安纳大学医学中心，99例药物难治性复杂部分性癫痫（MI-CPS）患者接受了术前评估，随后进行了前颞叶切除术。大多数患者在发作间期以及实际癫痫发作期间（发作期扫描）进行了单光子发射断层扫描（SPECT）。在94例发作间期扫描中，有54例（57%）在对应最终手术部位处出现局部脑灌注（rCP）降低。然而，发作期扫描的阳性率更高；在82例中有60例（73%）在实际癫痫发作期间观察到颞叶rCP增加，与手术侧一致。SPECT是一种用于定位考虑进行切除性手术的MI-CPS患者癫痫病灶的有用的非侵入性方法。发作间期和发作期SPECT都需要进行；同一病灶区域发作间期灌注减低和发作期灌注增加是致痫性病变所特有的。在大多数患者进行连续视频/脑电图监测期间，只需稍加额外努力就能进行发作期SPECT研究。将功能性脑成像（发作间期和发作期SPECT、PET）结果与癫痫发作的临床症状学、头皮和蝶骨电极脑电图、磁共振成像及其他非侵入性检查相结合，在大约三分之二的患者中可以推荐进行前颞叶切除术，而无需借助潜在危险的颅内脑电图监测。
