Treatment of epilepsy with bipolar electro-coagulation: an analysis of cortical blood flow and histological change in temporal lobe.
Treatment of epilepsy with bipolar electro-coagulation: an analysis of cortical blood flow and histological change in temporal lobe.
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DOI：
10.4103/0366-6999.149203
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发表时间：
2015-01-20
影响因子：
6.1
通讯作者：
Bao M
中科院分区：
文献类型：
--
作者：
Cui ZQ;Luan GM;Zhou J;Zhai F;Guan YG;Bao M
据报道，双极电凝治疗单纯电凝或联合电凝治疗累及功能皮质的癫痫有效。然而，双极电凝的机制尚不完全清楚。我们研究了24例难治性颞叶癫痫患者经双极电凝治疗后的急性皮质血流量和组织学变化。24例患者连续入组，根据入院日期分为三组。分析手术前后皮质区域血流（rCBF）、皮质电图、皮质损伤深度及急性组织学变化（H、E染色、神经元染色、神经丝（NF）染色）。采用t检验分析比较手术前后rCBF。凝血后rCBF明显降低（P < 0.05）。电凝后，尖峰明显减少。2 ~ 9 W电凝后颞叶皮质损伤深度分别为0.34±0.03、0.48±0.06、0.69±0.06、0.84±0.09、0.98±0.08、1.10±0.11、1.11±0.09、1.22±0.11 mm。输出功率4 ~ 5 W的凝固使分子层、外颗粒层、外锥体层的神经元和NF蛋白完全受损。电凝不仅破坏神经元和NF蛋白，而且使rCBF减少。我们认为电凝损伤可阻止癫痫放电的水平同步和扩散，部分破坏癫痫灶。
Bipolar electro-coagulation has a reported efficacy in treating epilepsy involving functional cortex by pure electro-coagulation or combination with resection. However, the mechanisms of bipolar electro-coagulation are not completely known. We studied the acute cortical blood flow and histological changes after bipolar electro-coagulation in 24 patients with intractable temporal lobe epilepsy. Twenty-four patients were consecutively enrolled, and divided into three groups according to the date of admission. The regional cortical blood flow (rCBF), electrocorticography, the depth of cortex damage, and acute histological changes (H and E staining, neuronal staining and neurofilament (NF) staining) were analyzed before and after the operation. The t-test analysis was used to compare the rCBF before and after the operation. The rCBF after coagulation was significantly reduced (P < 0.05). The spikes were significantly reduced after electro-coagulation. For the temporal cortex, the depth of cortical damage with output power of 2–9 W after electro-coagulation was 0.34 ± 0.03, 0.48 ± 0.06, 0.69 ± 0.06, 0.84 ± 0.09, 0.98 ± 0.08, 1.10 ± 0.11, 1.11 ± 0.09, and 1.22 ± 0.11 mm, respectively. Coagulation with output power of 4–5 W completely damaged the neurons and NF protein in the molecular layer, external granular layer, and external pyramidal layer. The electro-coagulation not only destroyed the neurons and NF protein, but also reduced the rCBF. We concluded that the injuries caused by electro-coagulation would prevent horizontal synchronization and spread of epileptic discharges, and partially destroy the epileptic focus.