Abstract: Objective To study the significance of electroencephalogram (EEG) before and after hemispherectomy and preoperative localization.Methods To summarize the clinical data of 12 patients who underwent cerebral hemispherectomy from April 2016 to April 2020 in the Epilepsy Center of Beijing Aviation General Hospital,and to analyze and summarize the characteristics of electroencephalogram (EEG) during the interictal period before surgery,during the interictal period and six months after surgery.Results Cranial magnetic resonance imaging (MRI) examination of 12 patients showed softening foci in one hemisphere and normal contralateral hemisphere.EEG background activity showed continuous asymmetry in both hemispheres,the EEG amplitude of the lesion side was significantly lower than that of the opposite side,intermittent discharge:bilateral brain discharge was detected in 5 patients,and the discharge sites of the other 7 patients were consistent with the lesion side.EEG in attack stage:the origin of attack was in the opposite side of the lesion in 1 patient,the origin of seizure was detected in 2 patients,and the origin of epileptic discharge in the remaining 9 patients was consistent with that in the lesion side.All patients received hemispherectomy or amputation on the side of the lesion.Postoperative follow-up was conducted to evaluate the surgical efficacy,electroencephalogram discharge and surgical complications.Twelve patients did not have seizures,and all patients were examined by electroencephalogram 6 months after surgery.Epileptic discharge disappeared in the contralateral interictal phase in 4 patients,and decreased slightly in the contralateral side in 1 case.The remaining 9 patients had slow wave discharge on the resection side and normal contralateral side.The EEG of 12 patients was basically normal one year after operation.Conclusion EEG has certain value for preoperative location diagnosis and prognosis evaluation of patients with cerebral softening lesions.When analyzing EEG of patients with cerebral softening lesions,imaging characteristics of patients should be fully analyzed.When the origin of EEG is in the same side with the softening lesions,hemispherectomy on the affected side can achieve better results.When bilateral abnormal discharge occurs,the possibility of good prognosis can not be ruled out,and hemispherectomy can be considered.When it is clear that the softened side is no longer functional,surgical resection is the best treatment.

Key words: Cerebral hemispheromalacia, Hemispherectomy, Electroencephalogram

摘要： 目的 研究患者脑电图在行病变侧大脑半球切除术前后表现及术前定位中的意义。方法 总结北京航空总医院癫痫中心自2016年4月至2020年4月行大脑半球切除手术的12例患者的临床资料并结合头颅核磁检查(MRI),分析总结其术前发作间期、发作期及术后半年复查时脑电图特点。结果 12例患者头颅核磁(MRI)检查均显示一侧大脑半球软化灶,对侧正常;脑电图背景活动表现为双侧半球持续不对称,病变侧脑电波幅明显较对侧低,间歇期放电:其中5例患者监测到双侧大脑放电,其余7例患者放电部位与病变侧相符;发作期脑电图:1例患者发作起源在病变对侧,2例患者监测到全面性发作,其余9例患者痫样放电起源与病灶侧相符。所有患者均接受了病变侧大脑半球切除术或离断术,术后进行随访,评估患者手术疗效、脑电图放电及手术并发症;12例患者没有癫痫发作,所有患者均在手术后6个月查脑电图,4例手术对侧发作间期痫样放电消失,1例对侧稍有减少,其余9例患者为切除侧慢波发放、对侧正常;术后1年复查脑电图12例患者都基本正常。结论 脑电图对大脑半球软化灶患者术前定位诊断及预后评估有一定的价值,分析脑软化灶患者的脑电图时要充分分析患者影像学特点,当脑电放电起源与软化灶同侧时,患侧半球切术,能取得较好的结果;当出现双侧异常放电时,也不排除手术可以获得良好预后的可能性,可考虑患侧半球切除术治疗;当明确软化侧已不存在功能时,手术切术为最佳治疗方案。

关键词: 大脑半球软化灶, 大脑半球切除术, 脑电图