基于MRI术后癫痫未完全缓解局灶性皮质发育不良患儿的分析  

Analysis of focal cortical dysplasia with children whose epilepsy was unrelieved thoroughly after operation based on MRI

作　　者：李林 易明岗 刘勇 崔若棣 董春华 高鑫 赵建设 LI Lin;YI Minggang;LIU Yong;CUI Ruodi;DONG Chunhua;GAO Xin;ZHAO Jianshe(The Center of Medical Imaging,Qilu Children’s Hospital of Shandong University,Jinan 250022,China)

机构地区：[1]山东大学齐鲁儿童医院医学影像中心,济南250022

出　　处：《癫痫杂志》2021年第6期492-496,共5页Journal of Epilepsy

基　　金：2018年济南市卫生和计划生育委员会科技计划项目(2018-01-31)。

摘　　要：目的分析基于MRI成像的孤立局灶性皮质发育不良(Focal cortical dysplasia,FCD)患儿术后癫痫未完全缓解的原因。方法回顾性分析2014年7月—2018年1月经病理证实且术后癫痫未完全缓解的21例孤立性FCD患儿的MRI及临床资料,分析其病理学类型及MRI征象,及不同MRI征象在每种病理类型FCD中出现的频次。分析手术失败的可能性因素。结果21例患儿中男15例、女6例,平均年龄(5.7±0.3)岁,平均病程(3.4±0.5)年,此部分患儿的MRI征象主要以局灶性灰白质分界模糊、皮质结构异常改变(增厚和/或变薄)、transmantle征(自皮层下白质向脑室方向延伸锥形异常信号)及灰白质异常信号为主要表现,与其他FCD患儿MRI征象类似。17例(80.9%)患儿术后2周~6个月脑电监测术区出现癫痫样放电,其中FCD I型与Ⅱ型分别占35.3%、64.7%。术中脑电监测,6例transmantle征区域未见癫痫样放电,只切除周围异常放电皮层区域,2例行transmantle征及周围异常放电区域全部切除,此两种切除方式,术后均有不同程度的癫痫发作。结论术后癫痫未完全缓解孤立性FCD的MRI征象无特异性,行致痫灶全部切除后仍有不同程度的癫痫发作,原因可能与潜在致痫因素有关。Objective To analyze the causes of unrelieved epilepsy thoroughly in children with isolated focal cortical dysplasia(FCD)based on MRI.Methods Retrospective analysis of MRI and clinical data of 21 children with isolated FCD during July 2014 to January 2018,which confirmed by pathology and unrelieved thoroughly after operation performed,the pathological types and MRI signs were analyzed,as well as the frequency of different MRI signs in FCD of each pathological type.Analyzed the possible factors of surgical failure.Results Among the 21 cases,there were 15 males and 6 females,with an average age of(5.7±0.3)years and an average course of disease of(3.4±0.5)years.MRI signs of this part of the children were mainly manifested by blurred focal gray matter boundaries,abnormal cortical structure changes(thickening and/or thinning),transmantle signs(abnormal cone signals extending from subcortical white matter to the ventricle)and abnormal gray matter signals,which were similar to MRI signs of FCD with satisfactory postoperative epilepsy control.17 cases(80.9%)appeared epileptic discharge after operation in the EEG monitoring area 2 weeks to 6 months,FCD type I and typeⅡaccounted for 35.3%,64.7%respectively.During intraoperative EEG monitoring,no epileptiform discharge was observed in the transmantle sign region in 6 cases,and the region was retained,and only the surrounding abnormal discharge cortex was removed,complete removal of the tansmantle sign and surrounding abnormal discharge area was performed in 2 cases,and different degrees of epileptic epilepsy were observed in both methods.Conclusion MRI signs of isolated FCD with unrelieved epilepsy after operation were nonspecific,there were still epilepsy of varying degrees after all epileptogenic lesions have been removed,the cause may be related to potential epileptic factors.

关 键 词：儿童 局灶性皮质发育不良 磁共振成像 神经外科手术 癫痫未缓解 

分 类 号：R742.1[医药卫生—神经病学与精神病学]