頭蓋内脳波における高周波解析を基に切除計画を立てた難治性てんかんの1手術例  [in Japanese] Epilepsy Surgery for Refractory Focal Epilepsy based on the Analysis of High Frequency Oscillations with Intracranial Electroencephalography : A Case Report  [in Japanese]

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Author(s)

    • 近藤 聡彦 Kondo Akihiko
    • 岡山大学大学院脳神経外科 Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
    • 吉永 治美 Yoshinaga Harumi
    • 岡山大学大学院発達神経病態学 Department of Child Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
    • 伊達 勲 Date Isao
    • 岡山大学大学院脳神経外科 Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
    • 上利 崇 Agari Takashi
    • 岡山大学大学院脳神経外科 Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
    • 岡 牧郎 Oka Makio
    • 岡山大学病院小児神経科 Department of Child Neurology, Okayama University Hospital
    • 林 裕美子 Hayashi Yumiko
    • 岡山大学大学院発達神経病態学 Department of Child Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
    • 柴田 敬 Shibata Takashi
    • 岡山大学大学院発達神経病態学 Department of Child Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
    • 新治 有径 Shinji Yukei
    • 岡山大学大学院脳神経外科 Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences

Abstract

 難治性新皮質てんかんの外科治療の際, 発作焦点の同定のために頭蓋内脳波記録は有用であるが, 脳波の解析法や結果の解釈の相違により切除範囲や手術成績に影響が生じ得る. 今回, われわれは難治性の後頭葉てんかん患者に対して, 慢性頭蓋内電極を留置し, 高周波律動 (HFO) の解析を行った. 独自のプログラムを用いてHFOの脳表カラーマップを作成し, マップ上のHFOの出現部位を参考に切除範囲を決定して, 焦点切除術を行った. 術後1年経過した現在, 発作は完全に抑制されている. 脳表カラーマップは発作時HFOの動的変化の視覚化に有用であり, この結果に基づいてHFO検出部位を切除範囲に含むことが良好な術後成績に寄与するものと考えられた.

  Intracranial electroencephalography (IEEG) is useful as an evaluation component of resective surgery when the results of noninvasive tests are incongruent in patients with refractory neocortical epilepsy. High-frequency oscillations (HFOs>80 Hz) have recently been recognized as having a strong relationship to the epileptogenic zone, and the complete resection of HFOs has been considered a favorable prognostic indicator for surgical outcome. It is sometimes difficult, however, to comprehend dynamic changes in ictal HFOs recorded via subdural electrodes.<br>  We performed surgical treatment on a medically intractable patient diagnosed with occipital lobe epilepsy after analyzing the patient's HFOs with IEEG using the original program. The patient has achieved seizure-free status one year after surgery. Our method of creating a brain surface topographic map of interictal HFOs and a topographic movie of ictal HFOs was useful for easy understanding of seizure onset zone and epileptic HFOs propagation. It may also be helpful for determining the necessary extent of surgical resection to include the epileptogenic zone, thus promoting better postsurgical seizure outcomes.

Journal

  • Japanese Journal of Neurosurgery

    Japanese Journal of Neurosurgery 24(1), 32-39, 2015

    The Japanese Congress of Neurological Surgeons

Codes

  • NII Article ID (NAID)
    130004842132
  • Text Lang
    JPN
  • ISSN
    0917-950X
  • Data Source
    J-STAGE 
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