MRI正常的难治性癫痫的手术疗效及相关因素分析  

Operative effect and pertinent factors analysis in intractable epilepsy patients with normal cerebral

作　　者：卢佩林[1] 高述礼[1] 辛涛[1] 姜绪涛[1] 张在金[1] 吕全江[1] 

机构地区：[1]解放军第四0一医院神经外科,青岛266071

出　　处：《中华神经外科杂志》2012年第9期931-934,共4页Chinese Journal of Neurosurgery

基　　金：青岛市2010-2012年科技发展计划一人口与健康的支撑项目（10-3-3-2-6-nsh）

摘　　要：目的探讨颅脑MRI检查正常的难治性癫痫患者的手术疗效及提示手术预后的相关因素。方法1997年8月至2010年10月间，对解放军第四O一医院手术治疗的难治性癫痫病例（出院≥1年），且经颅脑MRI检查未见异常的患者跟踪随访1—6年，并对获完整资料的62例患者进行分析。Engel分级Ⅰ、Ⅱ级视为预后良好，Ⅲ、Ⅳ级为预后不良，分析相关因素与手术疗效的关系。结果Engel分级Ⅰ、Ⅱ幺圾共47例，占76％。颞叶切除较额叶及顶枕叶皮质致痫灶切除的预后良好率高（P〈0．01）；而额叶及顶枕叶皮质致痫灶切除术后疗效差异无统计学意义；术前轻度发作的较重度发作组术后预后良好（P〈0．05）；手术后晚期出现发作的较早期出现发作预后不良（P〈0．05）；病理检查异常较病理正常的术后预后良好（P〈0．05）；手术时患者的年龄与预后无关。结论颅脑MRI正常的难治性癫痫，颞叶切除较颞叶外致痫灶切除预后良好，术前发作轻的、术后病理检查异常的也提示预后良好，手术后晚期出现发作者则预后不良。Objective To investigate the operative effect in intractable epilepsy patients with normal cerebral MRI and pertinent factors of indications about operative prognosis. Methods The study involved cases with intractable epilepsy undergone operative procedures between August 1997 and October 2010, released from our hospital a year and more. Of them, patients with normal cerebral MRI were followed up. Compiete clinical data from 62 patients were analyzed. By Engel standard, grade I and II are considered good prognosis, grade HI and IV are considered unsatisfactory results. Correlations between operative effect and good prognosis were evaluated. Results There are 47 cases with Engel grading I and II , accounting for 76%. Patients undergone temporal lobe cortex lesion resection had better prognosis than do those undergone frontal and occipital lobe lesion resection （P 〈 0. 01 ）. The operative effect between frontal and occipitoparietal lobe focus resection was not different significantly. Patients with slight pre - operative seizures had better prognosis than do those with sever seizures post - operatively （P 〈 0.05 ）. Patients with seizures long after operation have worse prognosis than early after operation （ P 〈 0. 05 ） . Patients with abnormal pathological exam had better prognosis than do those with normal pathological exam （ P 〈 0.05）. Ages were not correlated with prognosis. Conclusions In the intractable epilepsy patients whose cerebral MRI are normal, temporal lobe lesion resection signifies better prognosis than those lesion outside temporal lobe. Cases with slight pre - operative seizures and post - operative abnormal pathological exam signify better prognosis. Seizures appeared long after operation signifies worse prognosis.

关 键 词：磁共振成像 癫痫 外科手术 预后 术中诱发试验 

分 类 号：R742.1[医药卫生—神经病学与精神病学]