Стандартизированная предоперационная оценка при фармакорезистентной эпилепсии
DOI:
https://doi.org/10.52692/1857-0011.2025.2-82.08Ключевые слова:
лекарственно-резистентная эпилепсия, предоперационная оценка, видео-ЭЭГАннотация
Введение: Фармакорезистентная эпилепсия (ФРЭ) наблюдается приблизительно у трети пациентов с эпилепсией и сопровождается значительной заболеваемостью. Хирургическое лечение эпилепсии является эффективной терапевтической стратегией, требующей тщательной предоперационной оценки для правильного отбора пациентов и снижения функциональных рисков. Цель исследования: Провести развернутый обзор этапов стандартизированной предоперационной оценки при ФРЭ с акцентом на интеграцию неинвазивных и инвазивных методов для точной локализации эпилептогенной зоны и сохранения функционально значимых участков коры. Материалы и методы: Был проведён обзор литературы, охватывающий соответствующие исследования и руководства, описывающие все четыре этапа предоперационной оценки. Проанализированы диагностическая ценность, точность и ограничения каждого метода в построении гипотезы эпилептической сети. Результаты: Мультимодальная интеграция клинических, нейровизуализационных и нейрофизиологических данных позволяет точно локализовать эпилептогенную зону более чем в 70% случаев, существенно увеличивая шансы на успешный хирургический исход. Инвазивное функциональное картирование критически важно для снижения послеоперационных осложнений при вмешательствах в функционально значимые зоны коры головного мозга. Выводы: Стандартизированная мультимодальная предоперационная оценка имеет ключевое значение в ведении пациентов с ФРЭ. Этапное и индивидуализированное применение современных методов позволяет достичь оптимального баланса между эффективностью лечения и функциональной безопасностью.
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