Abstract: Objective To explore the efficacy and safety of stereotactic electroencephalography (SEEG)-guided radiofrequency thermocoagulation ablation in the treatment of refractory central zone epilepsy. Methods A retrospective analysis was conducted on 9 patients with refractory central zone epilepsy confirmed by SEEG from March 2019 to March 2024.The relationship between epileptogenic foci and functional cortex was precisely located in three-dimensional space.SEEG-guided radiofrequency thermocoagulation ablation was performed on the clearly identified epileptogenic initiation zone under awake conditions.Postoperative follow-up was conducted regularly,and the prognosis of patients was evaluated according to the Engel classification,as well as the status of epileptic seizures and neurological function impairment. Results A total of 70 electrodes were implanted in 9 patients.According to the SEEG results,45 electrodes were thermocoagulated.After 12 months of follow-up after thermocoagulation,6 patients (66.67%) were classified as Engel I,1 patient (11.11%) as Engel II,1 patient (11.11%) as Engel III,and 1 patient (11.11%) as Engel IV.The total effective rate (Engel I-III) was 88.89%.One patient had postoperative bleeding in the surgical area,one had facial paralysis,and eight had decreased muscle strength in one limb.After treatment with hyperbaric oxygen and limb rehabilitation,only one patient had slightly poor fine finger movement,and the neurological functions of the other patients were restored. Conclusion Radiofrequency thermocoagulation under SEEG guidance is an effective,minimally invasive and relatively safe method for treating intractable central zone epilepsy,and it has clinical promotion value.

Key words: Stereotactic electroencephalography, Radiofrequency thermocoagulation ablation, Central zone epilepsy, Drug-resistant epilepsy, Retrospective analysis

摘要： 目的 探讨立体定向脑电图(stereoElectroEncephaloGraphy,SEEG)引导下的射频热凝毁损术对于治疗难治性中央区癫痫的有效性及安全性。方法 回顾性分析2019年3月至2024年3月收治的9例经SEEG确定为难治性中央区癫痫患者,在三维空间内精确定位致痫灶与功能皮层的关系,对明确的致痫起始区在清醒状态下行SEEG引导下射频热凝毁损术,术后定期随访,根据Engel 分级评定患者预后,评估癫痫发作情况及神经功能损伤情况。结果 9例患者共植入70根电极,根据SEEG结果共热凝毁损45根电极,热凝术后随访12个月,其中Engel I级6例(66.67％),Engel II级1例(11.11％),Engel III级1例(11.11％),Engel IV级1例(11.11％),总有效率(Engel I-III级)88.89%。1例热凝毁损后出现术区出血,1例出现面瘫,8例出现单侧肢体肌力下降,通过高压氧及肢体康复等治疗后,仅1例遗留手指精细活动稍差,其余患者神经功能均恢复。结论 SEEG引导下的射频热凝毁损术是治疗难治性中央区癫痫的一种有效、微创且相对安全的方法,具有临床推广价值。

关键词: 立体定向脑电图, 射频热凝毁损术, 中央区癫痫, 药物难治性癫痫, 回顾性分析