扣带回癫痫外科治疗的预后及其影响因素分析  

Prognosis and influencing factors of surgical treatment in patients with cingulate epilepsy

作　　者：丁平[1] 袁柳 张绍辉[1] 梁爽爽[1] 于晓曼[1] 刘娜[1] 梁树立[1] Ding Ping;Yuan Liu;Zhang Shaohui;Liang Shuangshuang;Yu Xiaoman;Liu Na;Liang Shuli(Department of Neurosurgery,the First Affiliated Hospital of PLA General Hospital,Beijing 100048,China)

机构地区：[1]解放军总医院第一附属医院神经外科,北京100048

出　　处：《中华神经外科杂志》2018年第12期1207-1211,共5页Chinese Journal of Neurosurgery

基　　金：国家自然科学基金(81271437,81771388).

摘　　要：目的探讨扣带回癫痫患者的临床特点、手术预后及其相关影响因素。方法回顾性分析2003年1月至2016年10月解放军总医院第一附属医院神经外科进行切除性手术治疗37例扣带回癫痫患者的临床资料。统计不同类型扣带回癫痫的临床特点、手术方法及疗效,分析其症状学、脑电图等特点及术后癫痫无发作的影响因素。结果扣带回癫痫发作症状复杂,过度运动和恐惧症状在前扣带回癫痫多见;不对称强直多见于中、后扣带回癫痫;而视觉、幻觉症状仅见于后扣带回癫痫。37例患者均为切除性手术,其中病理灶切除术23例,脑叶及扣带回(含病理灶)切除术11例,癫痫灶切除术3例。其中12例(32.4%)患者在头皮脑电图上无法进行癫痫灶定位或定侧。术后1年随访癫痫元发作率为83.8%(31/37)。单因素分析结果显示,患者的MRI结果、癫痫灶在扣带回中的位置、病理灶的性质、头皮脑电图的结果等均与术后1年的癫痫元发作无明显的相关性(均P>0.05)。多因素logistic回归分析结果显示,术前智商较高的患者手术预后较好(OR=15.94,95% CI:1.081~234.869,P=0.044)。结论扣带回癫痫的症状学多样,头皮脑电图定位困难,切除性手术是治疗扣带回癫痫的有效方法。术前智商较高的患者术后预后较好。Objective To report the clinical characters,surgical treatment and outcomes of patients with cingulate epilepsy (CE).Methods We retrospectively analyzed the clinical data of 37CE patients who underwent resective operations at Department of Neurosurgery,the First Affiliated Hospital of PLA General Hospital from January 2003 to October 2016 and performed statistical study of seizure symptoms in different types of CE,surgical approaches and outcomes.In addition,the influencing factors were analyzed for patients who were postoperative seizure free.Results The semiology of CE varied.Hypermotor and fear were common symptoms in anterior CE and asymmetrical tonic seizure was more common in middle-posterior CE.However,visual and hallucinatory symptoms were exclusively reported in posterior CE.All 37 patients underwent resected surgery,including 23 cases of pathological focus resection,11cases of cerebral lobe and cingulate gyrus (including pathological focus)resection,and 3cases of epileptogenic zonectomy. Scalp EEG of 12(32.4%)patients was unable to provide lateralization and localization information for epileptogenic zone.The percentage of postoperative seizure free was 83.8%(31/37)at 1-year follow-up. Univariate analysis showed that MRI results,locations of epileptic foci or pathological lesions in the cingulate gyms,natures of pathological lesions,and results of scalp EEG were not significantly correlated with seizure-free after surgery(P >0.05).Multivariate logistic regression analysis showed that patients with higher intelligence quotient (IQ)before surgery had better surgical outcomes (OR =15.94,95% CI: 1.081-234.869,P =0.044).Conclusions The semiology of CE vary greatly and the scalp EEG can provide limited information for epileptogenic zone localization.Resective operation is an effective approach in the treatment of CE and high preoperative IQ may be a positive predictor for postoperative seizure-free.

关 键 词：癫痫 扣带回 神经外科手术 影响因素分析 

分 类 号：R651.1[医药卫生—外科学]