多次癫外科手术治疗的难治性癫临床病理学研究  

Clinicopathological study on refractory epilepsy treated by several epilepsy surgeries

作　　者：李岩[1] 刘永玲[1] 邢炜[1] 付静[1] LI Yan, LIU Yong-ling, XING Wei, FU Jing(Department of Pathology, Beijing Haidian Hospital, Beijing 100080, China)

机构地区：[1]北京市海淀医院病理科,100080

出　　处：《中国现代神经疾病杂志》2018年第2期134-141,共8页Chinese Journal of Contemporary Neurology and Neurosurgery

摘　　要：目的总结接受多次癫外科手术的难治性癫临床病理学特征和分型。方法共19例年龄≤20岁、接受2次或以上癫外科手术的难治性癫患者,16例(16/19)接受2次手术、3例(3/19)接受3次手术,两次手术后均行组织病理学检查,参照2011年国际抗癫联盟中局灶性皮质发育不良(FCD)分型标准和2007年世界卫生组织中枢神经系统肿瘤分类进行病理学诊断和分型。随访结束时采用Engel分级评价预后并计算预后良好率。结果手术间隔1~10年,平均4.24年。首次术后病理诊断为FCDⅠb型2例(2/19)、FCDⅡa型2例(2/19)、FCDⅢa型1例(1/19)、FCDⅢd型1例(1/19)、星形细胞瘤2例(2/19)、少突星形细胞瘤1例(1/19)、混合性生殖细胞肿瘤1例(1/19)、胚胎发育不良性神经上皮肿瘤1例(1/19)、错构瘤1例(1/19)、血管瘤1例(1/19)、灰质异位1例(1/19)、瘢痕脑回4例(4/19),仅行胼胝体切开术1例(1/19);再次术后病理诊断为FCDⅢa型4例(4/19)、FCDⅢb型4例(4/19)、FCDⅢc型1例(1/19)、FCDⅢd型8例(8/19)、双重病理[FCDⅢa型伴少突星形细胞瘤以及伴胶质瘢痕和(或)瘢痕脑回]2例(2/19)。再次术后随访0.50~5.00年、平均2.34年,EngelⅠ级10例(10/19)、EngelⅡ级6例(6/19)、EngelⅢ级3例(3/19),预后良好率84.21%。结论接受多次癫外科手术的难治性癫病理学分型主要是FCDⅢ型和双重病理。难治性癫患者手术效果不理想,部分经2或3次手术,发作控制较好。ObjectiveTo observe and investigate the clinicopathological features and types of refractory epilepsy treated by several epilepsy surgeries.MethodsThere were 19 patients with age less than 20 years who underwent 2（16/19）or 3（3/19）epilepsy surgeries.After pathological examination,pathological diagnosis and subtype was made according to focal cortical dysplasia（FCD）classification proposed by International League Against Epilepsy（ILAE）Diagnostic Methods Commission in 2011 and World Health Organization（WHO）Classification of Tumors of Central Nervous System in 2007.Results The operation intervals were 1-10 years（average 4.24 years）.The pathological diagnoses after first operation were FCDⅠb in 2 cases（2/19）,FCDⅡa in 2 cases（2/19）,FCDⅢa in one case（1/19）,FCDⅢd in one case（1/19）,5 cases of tumor lesions[2（2/19）of astrocytoma,one（1/19）of oligoastrocytoma,one（1/19）of mixed germ cell tumor,one（1/19）of dysembryoplastic neuroepithelial tumor（DNT）],one case（1/19）of hamartoma,one case（1/19）of angioma,one case（1/19）of heterotopic gray matter,and 4 cases（4/19）of ulegyria.The last one（1/19）underwent corpus callosal incision.Pathological diagnoses after reoperation were FCDⅢa in 4 cases（4/19）,FCDⅢb in 4 cases（4/19）,FCDⅢc in one case（1/19）,FCDⅢd in 8 cases（8/19）,dual pathology（FCDⅢa with oligoastrocytoma and with glial scar and/or ulegyria）in 2 cases（2/19）.Patients were followed up for 0.50-5.00 years after second or third operation（average 2.34 years）,and the results showed EngelⅠin 10 patients（10/19）,EngelⅡin6patients（6/19）and EngelⅢin 3 patients（3/19）.The rate of good prognosis was 84.21%.ConclusionsThe pathological diagnoses of brain tissue resected from patients accepting several epilepsy surgeries are mainly FCDⅢand dual pathology.It is suggested that the second or third operation would be effective for refractory epilepsy patients who underwent surgery already.

关 键 词：癫 神经外科手术 病理学 

分 类 号：R742.1[医药卫生—神经病学与精神病学]