局灶性皮质发育不良相关性难治性癫痫的手术预后及其相关影响因素分析  

Surgical outcome and prognostic factors in focal cortical dysplasia with intractable epilepsy

作　　者：林元相[1] 林堃[1] 康德智[1] 林章雅[1] 黄小芬[1] 王丰[1] 余良宏[1] 陈富勇[1] 

机构地区：[1]福建医科大学附属第一医院神经外科,福州350005

出　　处：《中华医学杂志》2012年第25期1763-1766,共4页National Medical Journal of China

基　　金：基金项目：福建省自然科学基金（2011J01164）;福建省高校新世纪优秀人才支持计划（NCETFJ-0702）

摘　　要：目的探讨局灶性皮质发育不良（FCD）相关性难治性癫痫（IE）致痫灶切除程度、病理亚型、MRS及MRI检查结果等与手术预后的相关性。方法回顾性分析2008年1月至2010年1月福建医科大学附属第一医院手术的35例FCD相关性IE随访12～36个月的手术效果，并分析致痫灶完全切除、病理亚型、MRI及MRS检查结果等与手术预后的相关性。结果术后Engel Ⅰ级62．7％（22／35），Ⅱ级14．3％（5／35），Ⅲ级17．2％（6／35），Ⅳ级5．8％（2／35）。致痫灶完全切除（P〈0．05）、FCDI型（P〈0．05）与良好的手术预后有明显相关性。颅脑MRI检查是否阳性，致痫灶对侧颞叶内侧海马区NAA／CHO＋Cr比值是否异常、MRS是否定侧与手术预后没有相关性。结论FCD相关性IE的总体手术效果良好。完全切除致痫灶、FCDI型与手术预后良好相关。Objective To analyze surgical outcome and relevant surgical parameters including resection extent of epileptogenic zone, pathological subtype, brain MRS and MRI results in FCD with intractable epilepsy. Methods We retrospectively analyzed surgical outcomes of 35 patients with intractable epilepsy related to focal cortical dysplasia, accepted surgery in the first affiliated hospital of Fujian Medical University from January 2008 to January 2010, with 12 - 36 months of postoperative follow-up. The relevances between complete resection, pathological subtype, MRS and MRI result and surgical outcome were statistically evaluated. Results 22 patients （ 66. 7% ） were Engel class Ⅰ , 5 patients （ 14. 3% ） were class Ⅱ,6 patients （17. 2% ） were class Ⅲ ,2 patients （5.8%） were class Ⅳ. Complete resection of epileptogenie zone （ P 〈 0.05 ） , FCD type I （ P 〈 0.05 ） correlated significantly with favorable surgical outcome. Other factors such as MRI results, abnormal NAA / CHO ＋ Cr ratio on the contralateral side of epileptogenic zone, as well as MRS-accurate lateralization did not influence outcome. Conclusion Overall,the surgical outcome of FCD is favorable. Complete resection, FCD type I correlates significantly with favorable surgical outcome.

关 键 词：大脑皮质 癫痫 预后 

分 类 号：R742.1[医药卫生—神经病学与精神病学]