With the improvement of the safety of neurosurgical interventional therapy and the increasing awareness of the long-term side effects of many antiepileptic drugs, the early surgery has changed purposefully, and more and more neurosurgeons will take the initiative to evaluate the condition of children with epilepsy syndrome during the treatment. At present, the standard of epilepsy surgery is to provide specific and detailed case information according to the damage degree of daily life activities, with the help of neurophysiology, anatomical lateralization and localization, such as Sturger-Weber syndrome (myotonia, spasm, etc. Is the main symptom) and other children's unique epilepsy syndrome, even if it can not reach refractory epilepsy, it should be operated as soon as possible before the cognitive and neurological deterioration of patients.
A variety of "black technology" Qi Li to overcome intractable epilepsy
The purpose of epilepsy resection is to make patients have no seizures, no drug treatment and no new defects. First, determine the brain region (epileptogenic focus) that causes seizures, and identify and preserve the complex cerebral cortex as much as possible, thus simultaneously reducing the probability of sudden death of children. At present, the determination of epileptogenic focus mainly depends on EEG, which provides lateral information for the determination of epileptogenic focus by reflecting synaptic activity in cerebral cortex. The generated video EEG records can be used as electrophysiological data for studying seizures and intervals. In addition, the clinical measurement of magnetoencephalography can record the tiny magnetic field of intracranial neurons through superconducting quantum interference device, and the current flow must be parallel to the skull surface, so that the vertical magnetic field generated and detected by magnetoencephalography sensor can provide guidance and direction for clinical treatment. At present, the therapeutic advantages of magnetoencephalography are divided into the following three points:
1, more sensitive: because the attenuation of magnetic field, bones and scalp is weaker than that of electric field, it is more sensitive to detect discharge.
2. Wider area: When epileptic cortical discharge is detected synchronously, the minimum cortical area of the peak value of MEG is 3-4 cm2, and that of scalp is 6-20cm2.
3. Higher resolution: Compared with EEG, MEG has higher spatial resolution in detecting epileptic spikes.
The combination of magnetoencephalography (MEG) and video electroencephalography (EEG) between seizures in children is helpful to locate the epileptic site. The consistency of the results provided powerful non-invasive evidence and ensured the success of the operation.
In addition, MRI and other structural imaging techniques are also applied to patients with medically refractory epilepsy, and cortical lesions have been identified by functional MRI in 20% of patients with medically refractory epilepsy. Another important structural imaging technique is diffusion tensor imaging (a special form of magnetic resonance imaging MRI) or fiber bundle imaging, which can be used before temporal lobectomy to minimize the risk of visual field defect.
Functional localization (mainly magnetic resonance spectroscopy), as a method to distinguish the local metabolic rate, has also been proved to lateralize the epileptic area of patients with focal cortical dysplasia, especially in identifying the functional cortex and main motor areas of the brain and determining specific examples of reactions (such as the aggravation of local cerebral blood flow, etc.). The emergence of various monitoring technologies makes the preoperative preparation of surgery more detailed. Next, as long as you find an experienced surgeon and perform accurate resection under the condition of controlling functional damage, the curative effect of epilepsy in children is very high. Professor James T. Rutka, director of the Cancer Research Center of the Children's Hospital affiliated to the University of Toronto, is such a powerful professor, focusing on the research of difficult brain diseases.
On July 6th, Professor James T. Ruttka came to China for an exchange. During this period, he will also conduct face-to-face consultation for five domestic children with neurosurgical diseases such as epilepsy, glioma (especially high-grade glioma such as DIPG, brain stem glioma and glioblastoma), cerebral palsy and families in need. If necessary, parents can seize this opportunity.