CAJ | 학술논문

目的探讨药物难治性癫痫患者经伽玛刀治疗后迟发性放射性脑水肿、脑坏死的临床治疗.方法总结解放军第452医院神经外科自1995年至2008年治疗的20例发生迟发性放射性脑水肿、脑坏死患者的临床特点,脑电图、MRI变化和治疗方法,其中14例患者接受药物保守治疗,6例有坏死灶形成、占位效应明显、癫痫发作加重且保守治疗无效的患者接受开颅手术切除坏死组织和邻近的癫痫放电病灶.结果除1例患者在脑疝形成后,因家属拒绝手术而死亡外,其余19例患者均较好地控制了癫痫、头痛等症状.保守治疗中5例和手术治疗中2例患者仍需继续抗癫痫药物治疗.2例患者脑水肿坏死发生时出现癫痫发作形式的改变,同步脑电图说明迟发性放射性脑水肿坏死灶可以导致新的致痫灶.结论癫痫患者经伽玛刀治疗后发生迟发性放射性脑水肿、脑坏死是常见的并发症,其发生有不可预测性及反复性,早期发现、早期治疗是避免出现严重后果的关键.在经过皮质激素加甘露醇或加中药治疗后,愈后较好.对有囊性坏死灶形成、占位效应明显、形成新的致痫灶者,手术治疗是改善症状、控制癫痫的有效方法.
목적 탐토약물난치성전간환자경가마도치료후지발성방사성뇌수종、뇌배사적림상치료.방법 총결해방군제452의원신경외과자1995년지2008년치료적20례발생지발성방사성뇌수종、뇌배사환자적림상특점,뇌전도、MRI변화화치료방법,기중14례환자접수약물보수치료,6례유배사조형성、점위효응명현、전간발작가중차보수치료무효적환자접수개로수술절제배사조직화린근적전간방전병조.결과 제1례환자재뇌산형성후,인가속거절수술이사망외,기여19례환자균교호지공제료전간、두통등증상.보수치료중5례화수술치료중2례환자잉수계속항전간약물치료.2례환자뇌수종배사발생시출현전간발작형식적개변,동보뇌전도설명지발성방사성뇌수종배사조가이도치신적치간조.결론 전간환자경가마도치료후발생지발성방사성뇌수종、뇌배사시상견적병발증,기발생유불가예측성급반복성,조기발현、조기치료시피면출현엄중후과적관건.재경과피질격소가감로순혹가중약치료후,유후교호.대유낭성배사조형성、점위효응명현、형성신적치간조자,수술치료시개선증상、공제전간적유효방법.
Objective To explore the clinical effect of gamma knife treatment in intractable epilepsy patients with delayed radiation-induced cerebral edema and/or necrosis.Methods The clinical feature,EEG,MRI and treatment modality data of 20 patients,admitted to our hospital from 1995 to 2008 and treated with gamma knife,were analyzed retrospectively.In all these patients,14 received conventional medical treatment and 6 adopted surgical removals of necrosis and epileptic focus resulting from the formation of necrotizing lesion,the apparent mass effect and aggravated seizures after conservative treatment.Results Except 1 patient died of cerebral hernia after giving up surgical treatment,all the other patients achieved good results in controlling the epilepsy and headache.Five in the medical group and 2 in the surgical group still needed anti-epileptic drugs.Two patients presented epilepsy of new type because of brain necrosis after radiation therapy and followed EEG demonstrated that radiation-induced delayed cerebral edema and/or necrosis could lead to new epileptogenie focus.Conclusions Radiation-induced cerebral edema and/or necrosis is a common complication in patients with epilepsy after gamma knife treatment which is unpredicted or repeated,thus early diagnosis and treatment are extremely important.Most patients can be cured with such drugs as corticosteroid combined with mannitol or Chinese herbal medicine.However,surgical treatment is needed in controlling the seizures and improving the symptoms once the cystic necrosis lesion,apparent mass effect and new epileptogenic focus appear.