【摘要】 目的研究颞叶外节细胞胶质瘤(GG)继发癫痫的临床特点和手术治疗方式及疗效。方法回顾性分析手术治疗并经病理证实的20例颞叶外节细胞胶质瘤继发癫痫患者的临床资料。术后癫痫控制效果按改良Engel分级标准评定;分析患者的发作表现、病变部位、影像学特点、病理改变、手术方式及病变切除程度与癫痫控制的关系。结果节细胞胶质瘤位于额叶者2例、顶叶7例、枕叶5例、颞枕交界处6例。MRI检查显示肿瘤为囊性者5例、囊实性6例、实性9例;增强扫描病变有强化12例,病变周围水肿5例。CT检查示病变有钙化4例。癫痫发作表现为简单部分性发作(伴意识保留的局灶性发作)者4例,复杂部分性发作(伴意识障碍的局灶性发作) 5例,继发性全面性强直阵挛(局灶进展到双侧的强直阵挛发作) 11例。肿瘤次全切除者2例,全切除15例,扩大切除3例。术后病理检查示合并脑皮质发育不良者2例。术后随访1～3年,癫痫控制效果为EngelⅠ级17例(85.0%),Ⅱ级2例(10.0%),Ⅲ级1例(5.0%)。预后相关临床因素分析显示,肿瘤切除的方式和程度与预后有关。结论颞叶外节细胞胶质瘤继发癫痫多为药物难治性,手术切除可取得良好效果。术前须综合评估病变部位和临床、影像学特点等资料制定手术策略,术中尽可能行肿瘤加致痫皮层全切除,以提高疗效。必要时可考虑先行SEEG电极植入后,再行致痫灶精准切除术。更多还原

【Abstract】 Objective To study the clinical features,surgical methods and surgical outcomes of epilepsy due to gangliogliomas(GG) in extra-temporal lobes.Methods The clinical data of 20 patients with epilepsy due to GG in extra-temporal lobes were retrospectively analyzed.Postoperative epilepsy control was graded according to the modified Engel classification standard and the relationship between epilepsy control and seizure manifestations, lesion location, imaging characteristics,pathological characteristics,surgical methods and extent of resection were analyzed.Results There were 2 cases with GG in frontal lobe,7 in parietal lobe,5 in occipital lobe,and 6 in the temporal occipital junction.MRI scan showed 5 cases of cystic,6 cases of cystic solid and 9 cases of solid.Enhanced scans of MR found lesion enhancement in 12 cases and edema surrounding the lesion in 5 cases.CT showed calcification in 4 cases.Four cases suffered simple partial seizures(focal aware seizures),5 cases were complex partial seizures(focal impaired awareness seizures),and 11 cases were generalized tonic-clonic seizures(focal to bilateral tonic-clonic seizures).2 cases obtained subtotal resection,15 total resection,and 3 extend resection.Postoperative pathological results combined with focal cortical dysplasia(FCD) were found in 2 cases.During the follow-up of 1-3 years,the prognosis was Engel Ⅰ in 17(85.0%) patients,Engel Ⅱ in 2(10.0%) and Engel Ⅲ in 1(5.0%).The analysis of related clinical factors showed that the prognosis was related to the method and extent of tumor resection.Conclusions Epilepsy due to GG in extra-temporal lobes is mostly drug-refractory, and surgical resection can achieve good results.Preoperative evaluation of the lesion location and imaging characteristics and other data were necessary for surgical planning.Total resection of tumor and epileptogenic cortex should be performed as much as possible to improve the curative effect.If necessary,the precise resection of epileptogenic foci after SEEG implantation can be considered.更多还原