致痫性局灶性皮质发育不良29例影像学特征、手术疗效和中期随访结果分析  

Epileptogenic focal cortical dysplasia:neuroimage,surgery and medium-term follow-up results in 29 cases

作　　者：王伟[1] 王伟民[1] 张晓鹏[1] 刘一兵[1] 王国良[1] 郭晓绯[1] 曹慧霞[2] 韩立新[2] 王蔚[3] 陈晓东[3] 

机构地区：[1]中国人民解放军神经外科中心,广州军区广州总医院神经外科,广州市510010 [2]中国人民解放军神经外科中心,广州军区广州总医院磁共振室,广州市510010 [3]中国人民解放军神经外科中心,广州军区广州总医院病理科,广州市510010

出　　处：《实用医学杂志》2012年第13期2130-2132,共3页The Journal of Practical Medicine

基　　金：广东省科技计划项目(编号:2008A030201021);军队临床高新技术重大项目(编号:2010GXJS033)

摘　　要：目的:探索致痫性局灶性皮质发育不良(FCD)的影像学特征和手术疗效。方法:自2005年8月至2008年11月行手术切除并有完整随访资料的FCD患者29例,其中在全麻唤醒麻醉下手术12例,导航指引下手术5例,8例合并海马硬化者行前颞叶切除术。随访患者并分析其临床表现、影像学特征及手术疗效。结果:术中病理检查显示FCD患者Ⅰa型2例,Ⅰb型3例,Ⅱa型11例,Ⅱb型13例。术后平均随访52个月,结果显示癫痫控制情况:Eagel分级Ⅰ级72.4%(21/29),EagelⅡ级20.7%(6/29),EagelⅢ级6.9%(2/29)。术后偏瘫3例,在3～6个月完全恢复2例,明显改善1例;轻度运动性失语1例,6周逐渐恢复。无手术死亡病例。结论:磁共振检查是FCD术前诊断的有效手段。脑电监测下致痫性FCD的完全切除是获得满意疗效的前提。Objective To explore the imaging characteristics and long-term outcome after epilepsy surgery of epileptogenie focal cortical dysplasia （FCD）. Methods We retrospectively analyzed 29 cases of epileptogenic FCD. The pre-surgical evaluation including semiology, MRI, EEG and PET scan was performed. All epileptic lesion resection （29 cases） were performed with intro-oprative EEG monitoring, in which 12 cases with awake craniotomy and 5 cases assisted with neuron-navigation. Anterior temporal lobectomy was applied in 8 cases which was suspected with hippocampal sclerosis. Results All 29 cases had at least one lesion on preoperative MRI. According to Palmini classification, the resected tissue was classified as FCD type Ⅱ b in 13 cases, Ⅱ a in Ⅱ cases, Ⅰ b in 3 cases and Ⅰ a type in 2 cases, respectively. After a mean follow-up of 52 months, for seizure control results, Eagel Ⅰ was achieved in 21 cases（72.4%）, Eagel Ⅱ in 6 cases （20.7%）, Eagel Ⅲ in 2 cases （6.9%）. Postoperative hemiplegia occurred in 3 cases, 2 of them gained full recovery in 3-6 months ; and 1 of them markedly improved. Mild motor aphasia occurred in 1 cases and completely resolved in 6 weeks. There was no operative mortality. Conclusions MRI is an effective means for preoperative diagnosis of FCD. Complete resection of epileptic cortical dysplasia with EEG monitoring is a prerequisite for seizure control.

关 键 词：癫痫 局灶性皮质发育不良 磁共振 外科手术 正点子发射断层扫描 脑电图 

分 类 号：R742.1[医药卫生—神经病学与精神病学]