CAJ | 학술논문

目的：分析颞叶低级别肿瘤并癫痫的临床特点，并探讨其手术治疗策略。方法回顾2013年1月至2014年1月27例颞叶低级别肿瘤并癫痫患者的临床资料，分析其临床特点、手术切除策略及术后疗效。结果全组病变部位分布于颞叶外侧、颞叶内侧、颞叶底面、颞后等各个区域，少数累及到颞叶以外脑区。发作首发症状分别为精神体验先兆、植物神经先兆、视幻觉、愣神、失语、自动运动、复杂运动甚至全面性强直发作等。27例中，病变手术全切除5例，扩大切除20例，次全切除2例。全组病例术后无严重并发症。发作控制：所有患者术后随访1年以上，仅1例次全切除者为EngelⅡ级，其余26例（96．3％）均为EngelⅠ级。结论颞叶低级别肿瘤并顽固性癫痫视病变部位及所累及致痫网络的不同而发作首症状表现各异；对颞叶低级别肿瘤并顽固性癫痫，应行严谨的术前评估致痫区与肿瘤的关系，周密设计切除计划，在保障安全前提下尽可能全切肿瘤以及充分切除致痫区，必要时结合神经导航、术中唤醒皮层电刺激功能区定位或颅内电极等技术；手术后发作控制效果佳。
목적：분석섭협저급별종류병전간적림상특점，병탐토기수술치료책략。방법회고2013년1월지2014년1월27례섭협저급별종류병전간환자적림상자료，분석기림상특점、수술절제책략급술후료효。결과전조병변부위분포우섭협외측、섭협내측、섭협저면、섭후등각개구역，소수루급도섭협이외뇌구。발작수발증상분별위정신체험선조、식물신경선조、시환각、릉신、실어、자동운동、복잡운동심지전면성강직발작등。27례중，병변수술전절제5례，확대절제20례，차전절제2례。전조병례술후무엄중병발증。발작공제：소유환자술후수방1년이상，부1례차전절제자위EngelⅡ급，기여26례（96．3％）균위EngelⅠ급。결론섭협저급별종류병완고성전간시병변부위급소루급치간망락적불동이발작수증상표현각이；대섭협저급별종류병완고성전간，응행엄근적술전평고치간구여종류적관계，주밀설계절제계화，재보장안전전제하진가능전절종류이급충분절제치간구，필요시결합신경도항、술중환성피층전자격공능구정위혹로내전겁등기술；수술후발작공제효과가。
Objective To analysis the clinical characters of temporal lobe epilepsy ( TLE ) associated with low-grade tumor and explore a suitable surgical stratagy .Methods The clinical data of 27 patients with TLE associated with low-grade tumor treated from January 2013 to January 2014 were analyzed retrospectively .The clinical characteristics ,surgical removal strategy and postoperative efficacy were analyzed.Results The lesions were located in lateral, mesial, basal, and posterior temporal lobe , respectively , and a few were extended to extemporal lobe .The earliest seizure semiology included psychiatric aura , autonomic aura, visual hallucination , dialeptic, aphasia, automotor, complex motor, and even generalized tonic-clonic seizure.Of 27 patients, 5 received total lesion resection , 20 underwent extensive resection , while 2 gained subtotal resection .No severe neural functional deficit was observed .After at least one year ’ s follow-up, except only one patient whose tumor wasn ’ t removed completely gained Engel Class Ⅱ, all 26 patients ( 96 .3%) gained Engel Class Ⅰ.Conclusions TLE associated with low-grade tumor could show various seizure semiology as tumors locate in various part of temporal lobe and involve different epileptic network.Strict presurgical evaluation is needed to indentify relationship of tumor and epileptogenic zone ,and to design suitable plan for thoroughresection of them in safety .When necessary ,techniques such as neuronavigation , awake surgery ,and intracranial electrodes implantation should be applied . Excellent seizure control can be achieved after surgery .