不同病理学类型儿童颞叶癫痫的临床因素及手术疗效分析  

Analysis of clinical factors and surgical outcome of temporal lobe epilepsy in children with different pathological types

作　　者：秦广彪[1] 马康平[1] 易林华[1] 谭泊静[1] 陈倩[2] 陈述花 毛莹莹[2] 栾燕飞 李云林[1] Qin Guangbiao;Ma Kangping;Yi Linhua;Tan Bojing;Chen Qian;Chen Shuhua;Mao Yingying;Luan Yanfei;Li Yunlin(Department of Neurosurgery,Children′s Hospital Affiliated to Capital Institute of Pediatrics,Beijing 100020,China;Department of Neurology,Children′s Hospital Affiliated to Capital Institute of Pediatrics,Beijing 100020,China)

机构地区：[1]首都儿科研究所附属儿童医院神经外科,北京100020 [2]首都儿科研究所附属儿童医院神经内科,北京100020

出　　处：《中华神经外科杂志》2020年第6期565-569,共5页Chinese Journal of Neurosurgery

摘　　要：目的分析不同病理学类型儿童颞叶癫痫的临床特点及手术效果。方法回顾性分析2016年9月至2019年5月首都儿科研究所附属儿童医院神经外科手术治疗的34例颞叶癫痫患儿的临床资料。其中位年龄为4.0岁(0.4~17.0岁);中位病程为16个月(1个月至13年)。34例患儿中,24例行标准前颞叶切除术,5例行占位病变扩大切除术,2例行选择性海马杏仁核切除术,2例行单纯颞叶病变切除术,1例行前颞叶+额叶结节切除术。对手术切除的组织标本进行病理学诊断。术后对所有患儿进行≥12个月的随访。依据病理学结果分为肿瘤组和非肿瘤组,比较两组间的年龄、性别、病程、癫痫发作类型以及Engel分级。结果34例患儿的手术均成功,所有患儿的MRI均显示病灶全部切除,术后无1例发生严重并发症。病理学诊断结果为混合性神经元-胶质肿瘤22例(64.7%),包括16例(47.1%)神经节细胞胶质瘤、3例(8.8%)胚胎发育不良性神经上皮肿瘤及3例(8.8%)不能分类的混合性神经元-胶质肿瘤;多形性黄色瘤型星形细胞瘤1例(2.9%);局灶性皮质发育不良8例(23.5%,6例伴海马硬化);结节性硬化症1例(2.9%);脑动静脉畸形1例(2.9%);无明确组织病理学诊断者1例(2.9%)。34例患儿的中位随访时间为24.5个月(12.0~43.0个月)。至末次随访,肿瘤组的患儿均未见复发。复查脑电图显示,2例患儿手术侧颞区仍有大量的痫样放电,余32例患儿痫样放电均较术前明显减少或消失。Engel分级为Ⅰ级29例,Ⅱ级3例,Ⅲ级1例,Ⅳ级1例。与非肿瘤组(11例)比较,肿瘤组(23例)年龄小[分别为11.0岁(2.8~14.0岁)、3.0岁(0.4~17.0岁),P=0.003]、病程短[分别为4.0年(0.3~13.0年)、1.0年(0.1~7.2年),P=0.008]。两组间的性别、癫痫发作类型及Engel分级比较,差异均无统计学意义(均P>0.05)。结论手术治疗的儿童颞叶癫痫中肿瘤较为常见,且多为神经节细胞胶质瘤,肿瘤患儿年龄小、病程短,与非Objective To analyze the clinical characteristics and surgical outcome of temporal lobe epilepsy in children with different pathological types.Methods A retrospective analysis was conducted on 34 children with temporal lobe epilepsy who underwent surgery at Department of Neurosurgery,Children′s Hospital Affiliated to Capital Institute of Pediatrics from September 2016 to May 2019.The patient’s age ranged from 0.4 to 17.0 years,with a median age of 4 years and a median duration of illness of 16 months(1 month to 13 years).Among the 34 patients,24 underwent standard anterior temporal lobectomy,5 received enlarged resection of mass lesions,2 underwent selective amygdalohippocampectomy,2 underwent resection of mass lesions only,and 1 received anterior temporal lobectomy plus resection of tuberous lesion in the frontal lobe.The tissue specimens underwent pathological examination.All those patients were followed up for≥12 months and were divided into tumor group and non-tumor group according to the pathological results.The age,gender,duration of illness,seizure type and Engel rating were compared between the 2 groups.Results All 34 patients underwent operation successfully.MRI showed that all the lesions were removed completely.No serious complications occurred after surgery.The pathological diagnosis was as follows:22 cases(64.7%)of mixed neuronal-glial tumors[including 16 cases(47.1%)of gangliogliomas,3 cases(8.8%)of dysembryoplastic neuroepithelial tumors and 3 cases(8.8%)of unclassified mixed neuronal-glial tumors],1 case(2.9%)of xanthoastrocytoma,8 cases(23.5%)of focal cortical dysplasia and 6 cases of which were accompanied by hippocampal sclerosis,1 case(2.9%)with tuberous sclerosis,1 case(2.9%)with cerebral arteriovenous malformation,and 1 case(2.9%)without definite histopathological diagnosis.The median follow-up duration of all 34 children was 24.5(12.0-43.0)months.By the last follow-up,MRI showed that there was no tumor recurrence in the tumor group.EEG(electroencephalography)showed that the epileptic

关 键 词：癫痫 颞叶 儿童 神经外科手术 治疗结果 

分 类 号：R726.5[医药卫生—儿科]