neurosurgeryНейрохирургияRussian journal of neurosurgery1683-32952587-7569Издательский дом "МедИНК"10.63769/1683-3295-2017-0-3-20-26neurosurgery-446Research ArticleОРИГИНАЛЬНАЯ РАБОТАORIGINAL REPORTХирургическое лечение мезиальной височной эпилепсии с использованием интраоперационной и хронической электрокортикографииSurgical treatment of mesial temporal epilepsy applying intraoperative and chronic electrocorticography (ECoG)ДенисоваНаталья ПетровнаDenisovaN. P.

врач-нейрохирург отделения функциональной нейрохирургии ФГБУ Федеральный Центр нейрохирургии, Новосибирск

630087, г. Новосибирск, ул. Немировича-Данченко, д. 132/1

n_denisova@neuronsk.ruРоговДмитрий ЮрьевичRogovD. Yu.

Врач-нейрохирург отделения функциональной нейрохирургии

630087, г. Новосибирск, ул. Немировича-Данченко, д. 132/1

d_rogov@neuronsk.ruХалепаАнастасия АнатольевнаHalepaA. A.

врач-нейрофизиолог

630087, г. Новосибирск, ул. Немировича-Данченко, д. 132/1

a_halepa@neuronsk.ruФГБУ Федеральный Центр нейрохирургииRussian Federation201726012018032026Copyright © Денисова Н.П., Рогов Д.Ю., Халепа А.А., 20182018Денисова Н.П., Рогов Д.Ю., Халепа А.А.Denisova N.P., Rogov D.Y., Halepa A.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.therjn.com/jour/article/view/446Цель работы

Цель работы: оценка эффективности хирургического лечения с использованием интраоперационной и хронической электрокортикографии (ЭКоГ) у пациентов с височной эпилепсией.

Материалы и методы

Материалы и методы. Хирургическое лечение проведено 20 больным с височной эпилепсией. Пациенты с симптоматической эпилепсией (опухолевые образования, АВМ)  были исключены из исследования. У 8 (40%) больных объем резекции определяли  интраоперационно с учетом данных ЭКоГ, у 3 (15%) — на основании данных МРТ и ЭЭГ, у 9  (45%) — зону резекции определяли по результатам хронической ЭКоГ. Катамнез составил от 12 до 36 мес.

Результаты

Результаты. Исходы оценивали по шкале ILAE: класс 1 достигнут у 10 (50%) пациентов, класс 3 (не более 3 дней с приступами за 1 год) — у 1 (5%) пациента; класс 4 (урежение  приступов более чем на 50%) — у 5 (25%); класс 5 (урежение приступов менее чем на 50%) — у 4 (20%). 

Заключение

Заключение. Определение объема резекции эпилептического очага под контролем ЭКоГ позволяет улучшить исходы оперативного лечения мезиальной височной эпилепсии.

Abstract

Abstract. Although temporal lobe epilepsy (TLE) is the most studied form of partial epilepsy, there are still many patients with drug  resistant forms. Temporal lobe surgery takes 50-73% of all epilepsy  surgery and can be an effective treatment for patients whose  seizures do not respond to best medical therapy. However the choice of surgical approach and extent of resection are controversial till nowadays.

Objective

Objective: to evaluate the surgical outcomes in patients with TLE using intraoperative and chronic ECoG.

Material and methods

Material and methods: 11 patients with TLE were included to this study. Patients with focal epilepsy caused by tumors (more than  Grade 2) and AVMs were excluded. The area of temporal lobe  resection was determine using intraoperative ECoG in 8 patients (40%), 3 patients (15%) underwent lobectomy determined with the help of MRI and EEG findings and at 9 patients (45%)  preoperative chronic ECoG was used for surgery planning. Follow-up period was 12-36 months.

Results

Results: Surgical outcome was evaluated according to ILAE scale, 10 patients (50%) became seizure-free and got Class 1, one patient  (5%) had only 3 days per year with seizures, which is Class 3. Five  patients (25%) achieved improvement after surgery and got Class 4. Four patients (20%) did not get any significant benefits from surgery and got Class 5.

Conclusion

Conclusion: ECoG-tailored resection provides better surgical outcome.

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The authors declare that there are no conflicts of interest present.