03-30生体磁気-学会誌-抄録集.qxp_レイアウト 1 2015/05/22 18:07 ページ 150 脳・解析、臨床 日本生体磁気学会誌 特別号 P3-7 Vol.28 No.1 2015 第 30 回日本生体磁気学会大会論文集 㞴ᛶ࡚ࢇࢇࡢ⾡ᘧ㑅ᢥࡢ Visual evoked field ࡢ᭷⏝ᛶ The efficacy of visual evoked field for the selection of epilepsy surgery Ᏹ⏣Ṋᘯ㸪㟢ཱྀᑦᘯ㸪ᕝᔱಇᖾ㸪బ⸨ⱥಇ㸪⏿ᘓ 㜰ᕷ❧ᏛᏛ㝔་Ꮫ◊✲⛉⬻⚄⤒እ⛉ Takehiro Uda, Naohiro Tsuyuguchi, Toshiyuki Kawashima, Hidetoshi Sato, Kenji Ohata Osaka City University Graduate School of Medicine Abstract For the indication of lobectomy or VEF ࡣࠊ๓᪉ࢫࢡ࣮ࣜࣥᢞᙳࡋࡓ㯮ⓑࡢࢳ࢙ࢵ ࣮࣮࢝࣎ࢻࢆ 500ms ẖ㌿ࡉࡏࡿ่⃭ࢆ⏝࠸ ࡓ(ᅗ㸯A)ࠋᝈ⪅ṇ㠃ᅛどࢆಁࡋࠊど㔝ࠊᕥど 㔝ࠊྑど㔝ࡢ୕ᅇࡢ่⃭ࢆ⾜ࡗࡓ(ᅗ㸯 B-D)ࠋゎ ᯒࡣ 100 ᅇࡢຍ⟬ᖹᆒࢹ࣮ࢱࢆ⏝࠸࡚ࢲ࣏࣮ࣝ ᥎ᐃἲ࡚⾜ࡗࡓࠋ multilober disconnection surgery, evaluation of residual brain function at epileptogenic brain is mandatory. Among the residual brain function, kinetic visual field test is a standard evaluation for visual function in the occipital lobe. However, in the patients in children or with mental retardation, this test is sometimes difficult to be achieved. In these situations, visual evoked field (VEF) by MEG can be one of the solutions as objective evaluation. In the present paper, we reported two cases that residual visual function was evaluated with VEF. In both cases, these evaluations resulted in the subsequent epilepsy surgeries. 1. ⥴ゝ ࡚ࢇࢇᑐࡍࡿ⬻ⴥษ㝖ࡸ㞳᩿⾡ࡢ㐺ᛂࡣࠊ (1)ᝈ⬻ࡢ࡚ࢇࢇཎᛶࡢᒁᅾ⛬ᗘࠊ(2)ᝈ⬻ࡢ ṇᖖ⬻ᶵ⬟ࡢṧᏑ⛬ᗘ ࡢ୧⪅ࡽ⥲ྜⓗุ᩿ ࡉࢀࡿࠋᚋ㢌ⴥࡢṇᖖどᶵ⬟ࡢṧᏑホ౯ࡋ࡚ࡣࠊ ║⛉ⓗど㔝᳨ᰝࡀࢫࢱࣥࢲ࣮ࢻ࡛࠶ࡿࡀࠊ ᑠඣࠊ ⢭⚄Ⓨ㐩㐜࡞ࡼࡾ║⛉ⓗど㔝᳨ᰝࡀᅔ㞴 ࡞ࡀ࠶ࡿࠋṧᏑどᶵ⬟ࡢホ౯࠾࠸࡚⬻☢ィࢆ ⏝࠸ࡓ Visual evoked field (VEF)ࡀ᭷⏝࡛࠶ࡗࡓ ࢆሗ࿌ࡍࡿࠋ 2. ᪉ἲ ᚋ㢌ⴥࡢ⬻ⴥษ㝖ࠊከ⬻ⴥ㞳᩿⾡ࡢ⾡๓ホ౯ ࡋ࡚ࠊ║⛉ⓗど㔝᳨ᰝࡢࠊVEF ࢆ⾜ࡗ࡚࠸ࡿࠋ 150 (ᅗ 1 visual evoked field A: ࢱࢫࢡᴫせ B: ど㔝่⃭ C:ᕥど㔝่⃭ D:ྑど㔝่⃭) 3. 1 ࡣ⏕ᚋ 6 ᭶ࡢᕥᛴᛶ◳⭷ୗ⾑⭘ࢆཎ ᅉࡍࡿእയᚋ࡚ࢇࢇࡢ 10 ṓ⏨ඣ࡛࠶ࡿࠋ Ⓨసᆺࡣ」㞧㒊ศⓎస࡛࠶ࡗࡓࠋMRI ࡛ࡣእയᚋ ࡢ⬻㌾ᡤぢࢆᕥᚋ㢌㢌㡬ഃ㢌ⴥࡳࡵ(ᅗ 2 A-C)ࠊFDG-PET ࡛ࡣྠ㒊⢾௦ㅰࡢపୗࡀࡳ ࡽࢀࡓࠋ㛫Ḟᮇ⬻ἼࠊⓎస⬻ἼࠊMEG ࡛ࡣᕥ ᚋ㢌ⴥ↔Ⅼࡀ♧၀ࡉࢀࡓ(ᅗ 2 D)ࠋ㍍ᗘࡢ⢭⚄Ⓨ 㐩㐜ὀពḞ㝗ከືᛶ㞀ᐖࡢࡓࡵಙ㢗ᛶࡢ㧗࠸ ║⛉ⓗど㔝᳨ᰝࡣྍ⬟࡛࠶ࡗࡓࠋVEF ࡛ࡣࠊ 03-30生体磁気-学会誌-抄録集.qxp_レイアウト 1 2015/05/22 18:07 ページ 151 日本生体磁気学会誌 特別号 Vol.28 No.1 2015 第 30 回日本生体磁気学会大会論文集 ࡓࢀ࡚࠸ࡓࠋ║⛉ⓗど㔝᳨ᰝ࡛ࡣྑୖ 1/4 ┣㹼༙ ┣ࡢ⤖ᯝ࡛࠶ࡗࡓࠋVEF ࡛ࡣྑど㔝่⃭࡛ᕥᚋ㢌 ⴥಙྕ※ࡀ᥎ᐃࡉࢀࡓࠋᮏᡤぢࡼࡾᕥᚋ㢌ⴥ どᶵ⬟ࡣ࠶ࡿ⛬ᗘṧᏑࡋ࡚࠸ࡿ⪃࠼ࡽࢀࡓࠋⓎ సࡢ᰿ࢆ┠ᣦࡋࠊ ᕥ༙⌫㞳᩿⾡ࢆ⾜ࡗࡓࠋ⾡ᚋࠊ Ⓨసࡣᾘኻࡋࡓࠋᮏேࡢ⮬ぬⓗࡣ࠶ࡲࡾኚࡣ ࡳࡽࢀ࡞ࡗࡓࡀࠊ║⛉ⓗど㔝᳨ᰝ࡛ࡣྑྠྡഃ ༙┣ࡀࡳࡽࢀࡓࠋ ど㔝่⃭(ᅗ㸱A)ࠊᕥど㔝่⃭(ᅗ㸱B)ࠊྑど㔝่ ⃭(ᅗ㸱C)ࡢ࠸ࡎࢀ࡛ࡶྑᚋ㢌㒊ಙྕ※ࡀ᥎ᐃ ࡉࢀࡓࠋᮏᡤぢࡼࡾྑど㔝ࡢどぬ୰ᯡࡣᕥᚋ㢌ⴥ ࡣᏑᅾࡋ࡞࠸⪃࠼ࠊᕥᚋ㢌ⴥ↔Ⅼษ㝖ࢆ⾜ࡗ ࡓࠋ⾡ᚋࠊ᫂ࡽ࡞ど㔝㞀ᐖࡢฟ⌧ࡣ࡞࠸ࠋ (ᅗ 2 A-C: ᕥᚋ㢌ⴥࠊ㢌㡬ⴥࠊഃ㢌ⴥࡢጤ⦰ᡤ ぢ D: ಙྕ※᥎ᐃ࡛ࡣᕥᚋ㢌ⴥࢲ࣏࣮ࣝࡀ 㞟✚ࠋ) (ᅗ 4 A-C: ᕥ๓㢌ഃ㢌㢌㡬ⴥᗈ⠊ᅖእയᚋኚ D: ಙྕ※᥎ᐃ࡛ࡣᕥഃ㢌ⴥࢲ࣏࣮ࣝࡀ 㞟✚ࠋ) 4. ⤖ㄒ VEF ࡼࡿᝈഃᚋ㢌ⴥࡢど㔝ᶵ⬟ṧᏑホ౯ࡀࠊ⾡ ᘧ㑅ᢥ᭷⏝࡛࠶ࡗࡓࢆሗ࿌ࡋࡓࠋ VEF ࡣ≉║⛉ⓗど㔝᳨ᰝࡀᅔ㞴࡞࡛ࡢᐈ ほⓗᣦᶆࡋ࡚᭷⏝࡛࠶ࡿ⪃࠼ࡽࢀࡓࠋ (ᅗ 3 A:ど㔝่⃭ࠊB:ᕥど㔝่⃭ࠊC:ྑど㔝่ ⃭ࠋ࠸ࡎࢀࡢ่⃭࡛ࡶྑᚋ㢌ⴥࢲ࣏࣮ࣝࡀ㞟 ✚ࠋ) 2 ࡣ㸯ṓ 4 ᭶ࡢᕥᛴᛶ◳⭷ୗ⾑⭘ࢆཎ ᅉࡍࡿእയᛶ࡚ࢇࢇࡢ 19 ṓ⏨ᛶ࡛࠶ࡿࠋ Ⓨసᆺࡣ」㞧㒊ศⓎసᙉ┤Ⓨస࡛࠶ࡗࡓࠋMRI ࡛ࡣࠊᕥ๓㢌ഃ㢌㢌㡬ⴥᗈ⠊ᅖእയᚋᡤぢࢆࡳ ࡵࡓࡀࠊᚋ㢌ⴥࡣಖࡓࢀ࡚࠸ࡓ(ᅗ 4 A-C)ࠋ㛫Ḟ ᮇ⬻ἼࠊⓎస⬻ἼࠊMEG ࡛ࡣᕥഃ㢌ⴥ ↔Ⅼࡀ♧၀ࡉࢀࡓ(ᅗ 4 D)ࠋFDG-PET ࡛ࡣᕥ༙⌫ ᗈ⠊ᅖ௦ㅰࡢపୗࡀࡳࡽࢀࡓࡀࠊᕥᚋ㢌ⴥࡣಖ 151
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