中华神经外科杂志
中華神經外科雜誌
중화신경외과잡지
Chinese Journal of Neurosurgery
2015年
11期
1122-1125
,共4页
闫红梅%遇涛%杜薇%朴媛媛%李勇杰
閆紅梅%遇濤%杜薇%樸媛媛%李勇傑
염홍매%우도%두미%박원원%리용걸
癫痫,颞叶%预后%局灶性皮质发育不良%海马硬化
癲癇,顳葉%預後%跼竈性皮質髮育不良%海馬硬化
전간,섭협%예후%국조성피질발육불량%해마경화
Epilepsy,temporal lobe%Prognosis%Focal cortical dysplasia%Hippocampal sclerosis
目的 探讨颞叶局灶性皮质发育不良(FCD)合并影像学表现不典型的海马硬化(HS)致癫痫患者手术预后的相关影响因素.方法 回顾性分析首都医科大学宣武医院功能神经外科术后病理学证实为FCD合并HS致癫痫患者的临床资料,共24例.患者术前MRI均无典型的HS表现.根据随访结果,Engel Ⅰ级为治疗成功组,Ⅱ~Ⅳ级为非治疗成功组.分析影响预后的可能因素.结果 术后随访24~70个月,平均42个月.17例FCD Ⅰ型患者中,治疗成功组有15例(15/17),非治疗成功组2例(2/17);7例FCDⅡ型患者中,治疗成功组有1例(1/7),非治疗成功组6例(6/7),差异有统计学意义(P=0.001).ⅠA与ⅠB型、ⅡA与ⅡB型患者预后差异无统计学意义.治疗成功组和非治疗成功组中,合并高热惊厥史的比例分别为4/16、7/8,全切除发作区的比例分别为16/16、4/8,差异均有统计学意义(P=0.008,P=0.007).两组间在性别、手术年龄、发作起始年龄、发作病程、术前发作频率、是否继发全面性强直阵挛发作、手术侧别、MRI是否显示颞叶病灶方面差异均无统计学意义(P>0.05).结论 FCD合并影像学表现不典型的HS致癫痫患者的手术预后与组织病理学亚型、是否有高热惊厥史、是否全切除发作区有关.
目的 探討顳葉跼竈性皮質髮育不良(FCD)閤併影像學錶現不典型的海馬硬化(HS)緻癲癇患者手術預後的相關影響因素.方法 迴顧性分析首都醫科大學宣武醫院功能神經外科術後病理學證實為FCD閤併HS緻癲癇患者的臨床資料,共24例.患者術前MRI均無典型的HS錶現.根據隨訪結果,Engel Ⅰ級為治療成功組,Ⅱ~Ⅳ級為非治療成功組.分析影響預後的可能因素.結果 術後隨訪24~70箇月,平均42箇月.17例FCD Ⅰ型患者中,治療成功組有15例(15/17),非治療成功組2例(2/17);7例FCDⅡ型患者中,治療成功組有1例(1/7),非治療成功組6例(6/7),差異有統計學意義(P=0.001).ⅠA與ⅠB型、ⅡA與ⅡB型患者預後差異無統計學意義.治療成功組和非治療成功組中,閤併高熱驚厥史的比例分彆為4/16、7/8,全切除髮作區的比例分彆為16/16、4/8,差異均有統計學意義(P=0.008,P=0.007).兩組間在性彆、手術年齡、髮作起始年齡、髮作病程、術前髮作頻率、是否繼髮全麵性彊直陣攣髮作、手術側彆、MRI是否顯示顳葉病竈方麵差異均無統計學意義(P>0.05).結論 FCD閤併影像學錶現不典型的HS緻癲癇患者的手術預後與組織病理學亞型、是否有高熱驚厥史、是否全切除髮作區有關.
목적 탐토섭협국조성피질발육불량(FCD)합병영상학표현불전형적해마경화(HS)치전간환자수술예후적상관영향인소.방법 회고성분석수도의과대학선무의원공능신경외과술후병이학증실위FCD합병HS치전간환자적림상자료,공24례.환자술전MRI균무전형적HS표현.근거수방결과,Engel Ⅰ급위치료성공조,Ⅱ~Ⅳ급위비치료성공조.분석영향예후적가능인소.결과 술후수방24~70개월,평균42개월.17례FCD Ⅰ형환자중,치료성공조유15례(15/17),비치료성공조2례(2/17);7례FCDⅡ형환자중,치료성공조유1례(1/7),비치료성공조6례(6/7),차이유통계학의의(P=0.001).ⅠA여ⅠB형、ⅡA여ⅡB형환자예후차이무통계학의의.치료성공조화비치료성공조중,합병고열량궐사적비례분별위4/16、7/8,전절제발작구적비례분별위16/16、4/8,차이균유통계학의의(P=0.008,P=0.007).량조간재성별、수술년령、발작기시년령、발작병정、술전발작빈솔、시부계발전면성강직진련발작、수술측별、MRI시부현시섭협병조방면차이균무통계학의의(P>0.05).결론 FCD합병영상학표현불전형적HS치전간환자적수술예후여조직병이학아형、시부유고열량궐사、시부전절제발작구유관.
Obsjective To investigate the related factors of operative prognosis influencing the focal cortical dysplasiain (FCD) with imaging atypical hippocampal sclerosis (HS) caused epilepsy in patients with operative prognosis.Methods The clinical data of 24 FCD patients with HS caused epilepsy confirmed by pathology after functional neurosurgical procedure at the Department of Functional Neurosurgery, Beijing Institute of Functional Neurosurgery from August 2006 to December 2009 were analyzed retrospectively.The patients did not have any manifestations of typical HS on MRI before procedure.According to the follow-up results, Engel grade Ⅰ was a successful treatment group and grade Ⅱ-Ⅳ was a non-successful treatment group.The possible factors affecting the prognosis were analyzed.Results The postoperative follow-up ranged from 24 to 70 months (mean, 42 months).Among the 17 patients with FCD type Ⅰ, 15 (15/17) were in the successful treatment group and 2 (2/17) were in the non-successful treatment group;among 7 patients with FCD type Ⅱ , 1 (1/7) was in the successful treatment group and 6 (6/7) were in the non-successful treatment group.There was significant difference (P =0.001).There were no significant differences in the prognoses of the patients between type Ⅰ A and type Ⅰ B or type Ⅱ A and type Ⅱ B.The proportions of the combined history of febrile seizure in the successful treatment group and the non-successful treatment group were 4/16 and 7/8 respectively, and the proportions of complete removal of the seizure onset zone were 16/16 and 4/8 respectively.There was significant difference (P =0.008, P =0.007).There were no significant differences in gender, age at operation, onset age, course of onset, preoperative seizure frequency, having secondary generalized tonicclonic seizures or not, operative sides, and revealing foci or not on MRI between two groups (P >0.05).Conclusions The operative prognoses of the patients with FCD and imaging atypical HS caused epilepsy are associated with histopathological subtypes, having a history of febrile seizure or not, total resection of seizure onset zone.