颞叶内侧癫痫伽马刀术后引起脑淀粉瘤一例  

A case of secondary cerebral amyloidoma after gamma knife radiosurgery for medial temporal epilepsy and literature review

作　　者：胡玮冰 李恺煇 费凌霞 胡湘蜀 李淡芳 李海南 HU Weibing;LI Kaihui;FEI Lingxia;HU Xiangshu;LI Danfang;LI Hainan(Epilepsy Center,Guangdong 999 Brain Hosipital,Guangzhou 510515,China;Pathology apartment,Guangdong 999 Brain Hosipital,Guangzhou 510515,China)

机构地区：[1]广东三九脑科医院癫痫中心,广州510000 [2]广东三九脑科医院病理科,广州510000

出　　处：《癫痫杂志》2020年第5期396-401,共6页Journal of Epilepsy

摘　　要：目的报道一例因颞叶内侧癫痫行伽马刀术,术后7年发现颅内占位性病变,手术部分切除1年后病变进展,探讨伽马刀术后长期并发症—继发性脑淀粉瘤的相关特点及相关文献复习。方法分析患者的临床表现、术前及术后头部影像学、间歇期及发作期脑电图(EEG)及(再手术的)组织病理学特点。结果患者22岁出现癫痫发作,主要表现为植物神经症状及全身强直阵挛发作,36岁行右侧颞叶内侧伽马刀术;术后7、8年,患者分别于43、44岁时出现左侧肢体偏瘫和认知功能下降,头部核磁共振成像(MRI)分别表现为右侧额顶叶囊实性占位性病变、右侧额顶叶未切除囊实性病变增大,44岁时间歇期及发作期EEG可见右半球近持续性慢波增多、右侧中后颞及中央-顶区癫痫样放电,行手术部分切除,病理组织学可见淀粉样物质沉积并淀粉瘤形成,伴出血性改变,再次行“右侧额颞中央区病变切除+致痫灶切除术”,术后继续口服拉莫三嗪50 mg每日两次、奥卡西平0.3 g每日两次,术后3、6个月随访未见癫痫发作,当地医院复查MRI未见复发。结论伽马刀术后数年可能引起继发型脑淀粉瘤,不完全切除极易复发加重。Objective To clarify the characteristic of secondary cerebral amyloidoma which is relapsing in one year after seven years gamma knife radiosurgery and review relevant literature.Methods To analyze the clinical manifestation,preoperative and postoperative MRI imaging,inter-ictal and ictal electroencephalogram(EEG)and histopathological evaluation.Results The patient suffered from epilepsy(mainly autonomic seizure and global tonicclonic seizure)at the age of 22 and took a gamma knife radiosurgery for right medial temporal epilepsy as the refractory seizures occurred at the age of 36.In her 43 and 44 years’old,she suddenly found left hemiplegia and mental retardation,the MRI showed right frontal and parietal space-occupying lesion and relapsed after the partial excision respectively,the inter-ictal and ictal EEG displayed persistent slow wave in the right hemisphere and spike wave located in the right posterior temporal and central-parietal,after the surgery,we found amyloid in the histopathological evaluation.Conclusion One of the delayed complications of gamma knife radiosurgery is secondary cerebral amyloidoma,and partial excision may induced relapsing easily.

关 键 词：伽马刀 术后 脑淀粉瘤 颞叶内侧癫痫 

分 类 号：R651.1[医药卫生—外科学]