幕上胶质瘤继发癫痫患者皮层脑电异常放电脑组织的病理学研究  

Pathological features of brain tissues with electrocorticographic abnormalities on secondary epilepsy in patients with supratentorial glioma

作　　者：方升[1,2] 熊伟茗[1] 但炜[1] 王超[1] 詹彦[1] 谢延风[1] 石全红[1] 

机构地区：[1]重庆医科大学附属第一医院神经外科,重庆400016 [2]成都市第三人民医院神经外科,成都610031

出　　处：《第三军医大学学报》2013年第1期54-56,共3页Journal of Third Military Medical University

基　　金：重庆市卫生局重点课题(2012-1-008)~~

摘　　要：目的探讨幕上胶质瘤继发癫痫患者皮层脑电异常放电脑组织的病理学改变。方法选择28例首次以癫痫发作入院的非功能区胶质瘤患者,在术中皮层脑电(electrocorticography,ECoG)监护下行肿瘤切除+痫样放电切除术。将切除有癫痫样放电的脑皮质作为试验组,无痫样放电的显微镜下显示肿瘤周边正常的哑区组织(胶质瘤切除附带)或内减压脑组织作为对照组。分析比较试验组与对照组术后病理检查的结果及试验组ECoG波型特点。结果①病理特点:28例试验组中15例(53.57%)发现胶质瘤细胞,7例(25.00%)单纯胶质细胞增生,6例(21.43%)患者示脑组织充血水肿。13例对照组中3例(23.08%)出现胶质细胞增生,6例(46.15%)单纯充血水肿,4例(30.77%)为正常脑组织。术后病理检查结果显示,试验组胶质瘤或胶质增生明显高于对照组(P<0.05)。②ECoG波型特点:试验组28例中22例术后病检显示胶质瘤或胶质增生者,ECoG显示17例(77.27%)为反复出现的单个极高幅棘波、多棘慢波,5例(22.72%)为高幅尖波节律;6例脑组织充血水肿者ECoG显示1例(16.67%)为高幅尖波节律,4例(66.67%)呈多灶性间隙性成簇出现的中高幅多棘波/多棘尖波,1例(16.67%)为散在于背景中单个棘尖波/棘尖慢波。结论幕上胶质瘤继发癫痫患者ECoG异常放电脑组织的病理学改变多表现为胶质瘤细胞和胶质细胞增生;胶质瘤周围ECoG反复出现极高幅棘波、棘尖波和尖波节律放电的脑皮质区应积极处理。Objective To explore the pathological features of brain tissues with electrocorticography（ECoG） abnormalities on the secondary epilepsy in patients with supratentorial glioma.Methods Twenty-eight patients with nonfunctional areas glioma who were admitted by seizures for the first time were enrolled.By the ECoG monitoring,the patients underwent the resection of tumor and epileptic discharge tissues.The resected brain cortices with epileptic discharges were collected as an experimental group（n=28）,and normal dumb tissues（parenthesis of glioma resection） or decompression brain tissues in tumor surrounding area observed by microscopy without epileptic discharges were collected as a control group（n=13）.The postoperative pathologic results were analyzed and compared between the experimental group and control group,and the characteristics of specific ECoG wave were analyzed in the experimental group.Results ①Pathological features： In the experimental group,glioma cells were found in 15 cases（53.57%）,simple glial cell proliferation was found in 7 cases（25.00%）,and brain congestion and edema was found in 6 cases（21.43%）.In the control group,focal gliosis was found in 3 cases（23.08%）,simple congestion and edema was found in 6 cases（46.15%）,and normal brain tissue was found in 4 cases（30.77%）.The postoperative pathological examination found that the incidence of glioma or gliosis in the experimental group was significantly higher than that in control group（P0.05）.②Characteristics of ECoG wave in the experimental group： In the 22 cases that were confirmed as glioma or gliosis by postoperative pathological examination,17 cases（77.27%） had recurring single high amplitude spikes and multispike-slow wave in ECoG,and 5 cases（22.72%） had high amplitude sharp wave rhythm.In the other 6 cases that were confirmed as congestion and edema by postoperative pathological examination,1 case（16.67%） had high amplitude sharp wave rhythm,4 cases（66.67%） had clustered medium-h

关 键 词：皮层脑电图 幕上胶质瘤 继发性癫痫 病理学 

分 类 号：R446.8[医药卫生—诊断学] R739.41[医药卫生—临床医学]