Objective To analyze the value of stereotactic electroencephalogram(SEEG)in preoperative evaluation of epilepsy caused by heterotopic gray matter,and to explore the operative manner selection for patients with epilepsy caused by different types of heterotopic gray matter.Methods A retrospective analysis was performed on 16 patients with drug-refractory epilepsy induced by heterotopic gray matter treated in Department of Neurosurgery,Tangdu Hospital,Air Force Medical University from April 2019 to May 2022.Among them,there were 7 cases of single nodule in periventricular nodular heterotopia(PNH),2 cases of bilateral PNH with multiple nodules,and 7 cases of subcortical heterotopia with local cortical dysplasia.After non-invasive preoperative evaluation,robot-assisted SEEG implantation was performed.According to the results of SEEG and electrical stimulation,different operative manners were individually selected.All patients were followed up for more than 1 year.Results Seven cases of single nodule in PNH were treated with SEEG-guided radiofrequency thermocoagulation.After 1 year of postoperative follow-up,5 cases achieved Engel Ⅰ and 2 cases achieved Engel Ⅱ.Two patients with multiple nodules in PNH were treated with vagus nerve stimulation and followed up for 2 years,with the effect reaching Engel Ⅳ.Four patients with abnormal discharge of subcortical heterotopic gray matter and covered cortex were treated with excision of heterotopic gray matter and related cortex.The abnormal discharge in 3 patients started independently from the covered cortex,and the relevant cortex was resected only.The postoperative follow-up ranged from 1 to 3 years,and the efficacy reached Engel Ⅰ.Conclusion Epilepsy caused by heterotopic gray matter often belongs to drug-refractory epilepsy.SEEG plays an important role in the localization of epilepsy foci.Individualized operative manners for different types can achieve satisfactory results.
维普
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