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目的:探讨立体定向脑电图（SEEG）引导下致痫灶切除术治疗药物难治性癫痫患儿的有效性及安全性。方法:选择航空总医院癫痫中心自2015年1月至2022年3月应用SEEG引导下致痫灶切除术治疗的126例药物难治性癫痫患儿（<18岁）为研究对象，回顾性分析患儿的临床资料和疗效（术后1年采用Engel分级评估患者的预后）。结果:（1）126例患儿共植入1 289根电极，平均每个患者（10.09±2.92）根，其中单侧植入55例，双侧植入71例。平均脑电监测时间（8.69±5.71） d，范围3~28 d。首次SEEG电极植入后可成功定位致痫灶患儿114例（90.5%），为精确定位二次调整电极植入12例（9.5%）。（2）126例患儿中行单一脑叶切除27例（21.4%），多脑叶联合或多部位剪裁式切除36例（28.6%），局灶剪裁式皮层切除60例（47.6%），局灶剪裁式皮层切除或海马杏仁核切除联合胼胝体切开术3例（2.4%）。13例患儿（植入17根电极）术中采用实时小切口探查止血，术后CT显示正常。4例患儿SEEG电极植入后出现少量无症状性硬膜外、硬膜下或脑实质血肿，均自行吸收。所有患儿均无感染、脑脊液漏、死亡或严重致残发生。（3）126例患儿随访（26.1±7.26）个月，术后1年随访时Engel分级Ⅰ级66例、Engel分级Ⅱ级33例、Engel分级Ⅲ级21例、Engel分级Ⅳ级6例。126例患儿中13例为既往手术失败、第2次行SEEG引导下致痫灶切除术治疗，术后1年随访时Engel分级Ⅰ级8例、Engel分级Ⅱ级2例，占76.9%（10/13）。结论:SEEG引导下致痫灶切除术治疗药物难治性癫痫患儿安全有效。初次手术效果不佳的患儿可通过SEEG重新定位致痫灶、再次手术切除致痫灶，也可获得较好疗效。

Objective:To discuss the efficacy and safety of stereotactic electroencephalography (SEEG) in epileptogenic foci excision in pediatric patients with drug-resistant epilepsy.Methods:A total of 126 pediatric patients (<18 years old) with drug-refractory epilepsy who received SEEG-guided epileptogenic foci excision in Epilepsy Center, Aviation General Hospital from January 2015 to March 2022 were selected. The clinical data and efficacy were retrospectively analyzed, and prognoses of these pediatric patients were evaluated by Engel grading 1 year after resection.Results:(1) A total of 1289 electrodes were implanted, with a mean of (10.09±2.92) electrodes per pediatric patient; 55 pediatric patients had unilateral implant and 71 had bilateral implant. Mean EEG monitoring time was (8.69±5.71) d, ranged 3-28 d. Epileptogenic focus could be located in 114 pediatric patients (90.5%) after initial implantation under SEEG monitoring, and secondary implantation for accurate positioning was given in 12 pediatric patients (9.5%). (2) Lobectomy was performed in 27 pediatric patients (21.4%), multi-lobectomy or tailored cortical resection in 36 (28.6%), tailored cortical resection on single lobe in 60 (47.6%), and tailored cortical resections on single lobe or hippocampal amygdala resection combined with corpus callosotomy in 3 (2.4%). Minimally invasive exploring hemostasis under SEEG was performed in 13 pediatric patients (17 electrodes) and postoperative CT was normal. A little asymptomatic epidural, subdural or cerebral parenchymal hematoma spontaneously absorbed was noted in 4 pediatric patients after implantation under SEEG monitoring. No perioperative infection, CSF leakage, death or severe disability was noted. (3) Mean follow-up was performed for (26.1±7.26) months; 66 (52.3%) pediatric patients reached Engel grading I, 33 (26.2%) reached Engel grading II, 21 reached Engel grading III (16.7%), and 6 (4.8%) reached Engel grading IV. Thirteen pediatric patients with failed resection received SEEG-guided epileptogenic foci excision for the second time: 8 (76.9%) had Engel grading I and 2 had Engel grading II 1 year after follow-up, accounting for 76.9% totally.Conclusion:SEEG-guided epileptogenic foci excision is safe and effective in drug-refractory epilepsy; for pediatric patients with poor initial results, SEEG can be used to relocate the epileptogenic focus, and a second resection of epileptogenic focus can also obtain good results.