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1、CT与MRI图像融合辅助立体定向手术治疗难治性癫痫郭效东王本瀚陆卫风刘明辉郝文明吴艳芝任廷文杨俊国赵学鼎（解放军第153中心医院全军神经外科中心，河南郑州）摘要目的探讨立体定向下颅内多靶点联合射频毁损术治疗难治性癫痫的疗效、安全性和并发症。方法对65例难治性癫痫患者采用CT/MRI图像融合技术，手术计划系统确定颅内靶点，应用射频热凝对胼胝体、杏仁核、海马、Forel-H区、扣带回等多靶点组合毁损。术后长期随访，采用谭启富癫痫术后恢复评价标准及Engel(1987)评价标准进行疗效评定。结果术后65例全部有效随访，随访时间3个月～6年，平均2.7年，满意5例(7%)，显著改善19
2、例(29%)，良好26例(40%)，效差13例(20%)，无改善2例(3%)，有效率为96.6%；按Engel标准评价Ⅰ级6例(9%)，Ⅱ级23例(35%)，Ⅲ级34例(52%)，Ⅳ级2例(3%)。术后出现一过性并发症45例，经对症治疗均在1-4周内恢复，无永久性并发症。结论CT与MRI图像融合辅助立体定向手术治疗难治性癫痫是一种安全、有效、微创的治疗方法。关键词图像融合；立体定向；难治性癫痫；疗效；射频毁损StereotacticradiofrequencyablationbyCTandMRIimagerebuildedandmergedforrefractoryepilep
3、syGuoXiaodongWangBenhanLuWeifengLiuMinghuiHaoWenmingWuYanzhiRenTingwenYangJunguoZhaoXuedingDepartmentofNeurosurgery,153rdHospitalofPLA,zhengzhou,chinaAbstractObjectiveToassessthesafety,efficacyandcomplicationsofstereotacticradiofrequencyablationoftheintracranialmulti-nucleusassociationforref
4、ractoryepilepsy.Methods65refractoryepilepsypatientswereperformedbyusingmagneticresonanceimaging(MRI)andcomputedtomography(CT)imagerebuildedandmerged,operationplanningsystemlocatingandcombiningintracranialtarget,forexamplecorpuscallosum,amygdaloidnucleus,amygdalaandhippocampus,Forel-Hfieldand
5、cingulategyrus,thesegargetswerelesionedbystereotacticradiofrequencyablation.Allpatientsgainedalong-timefollow-upvisitsfromthreemonthstosixyears.Post-operationtheclinicaloutcomeswereassessedbyevaluationcriterionofprofessorTan-QifuandEngel’sclassification(1987).ResultsAllofpatientswerefollowed
6、upfrom3monthstosixyears(mean,2.7years)normally,fivecasesofthem(7%)weregratification,19patients(29%)weresignificantimprovement,26patients(40%)werefine,and13cases(20%)werepartialeffect,anothertwocaseswereineffective;accordingtoEngel’sclassification,sixcasesofthem(9%)wereEngelI,twenty-three(35%
7、)wereEngelII,34(52%)wereEngelⅢ,andtwocases(3%)wereEngelIV.45patientsofthemappearedtemporarycomplications,butallcomplicationsgotrecoveryfromonetofourweeksbysymptomatictreatment,noseverepermanentmorbidity.ConclusionStereotacticradiofrequencyablationo
