以Transmantle征为主要MRI征象局灶性皮质发育不良所致难治性癫痫患儿手术预后分析  

Prognostic analysis of children with focal cortical dysplasia taking Transmantle sign as the main MRI performance

作　　者：李林 孙志群[2] 赵建设 崔若棣 李方元 LI Lin;SUN Zhiqun;ZHAO Jianshe;CUI Ruodi;LI Fangyuan(The Center of Medical Imaging,Qilu Children’s Hospital of Shandong University,Jinan 250022,China;New Pediatricl Department,Weifang People’s Hospital of Shandong Province,Weifang 261071,China;Department of Imaging,Jinan Southern Suburb Hospital,Jinan 250000,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 [2]山东省潍坊市人民医院新生儿科,潍坊261071 [3]济南南郊医院影像科,济南250000

出　　处：《癫痫杂志》2022年第3期217-221,共5页Journal of Epilepsy

摘　　要：目的 探讨以Transmantle征(T2WI或T2 FLAIR序列白质内向脑室方向延伸锥形高信号)为主要磁共振成像(Magnetic resonance imaging,MRI)征象的局灶性皮质发育不良(Focal cortical dysplasia,FCD)患儿术后癫痫控制情况,并分析诸因素对手术预后的影响。方法 回顾性分析2015年5月—2020年3月于山东大学齐鲁儿童医院经病理证实的56例以Transmantle征为主要MRI征象的FCD患儿,其中男33例、女23例,平均年龄(4.8±0.13)岁,分析其影像学及临床资料。分析其病理学类型及主要MRI征象、癫痫样放电范围、术后Engel分级情况。分析手术方式、发病类型、手术年龄、致痫部位、病程及围手术期癫痫发作对患儿手术预后的影响。结果 术后病理示56例患儿均为FCDⅡb型,MRI征象除Transmantle征外,还伴有局灶性灰白质分界模糊、皮质结构异常、灰白质内异常信号灶等。术中脑电监测结果示所有病例癫痫样放电区域均大于MRI所示病灶范围。术后Engel分级:Ⅰ级25例(43.8%)、Ⅱ级18例(31.3%)、Ⅲ级4例(6.3%)、Ⅳ级9例(18.8%)。手术切除方式及围手术期有无发作是影响患儿手术预后的独立因素(P<0.05)。结论 手术方式及围手术期有无发作与患儿预后密切相关。Objective Discussed the postoperative seizure control situation of children with focal cortical dysplasia(FCD),which took Transmantle sign(T2WI or T2 FLAIR sequence inward extension cone high signal in the direction of ventricle) as the main MRI performance,and analyzed the influence of various factors on the prognosis of surgery.Methods Retrospective analysis was performed on 56 children with FCD with Transmantle signs as the main MRI signs confirmed by pathology in Qilu Children’s Hospital of Shandong University from May 2015 to March 2020,including 33 males and 23 females,with an average age of(4.8±0.13) years,and their imaging and clinical data were analyzed.Analyzed the pathological types and main MRI signs,the range of epileptiform discharge,and Engel classification after surgery.Analyzed the effect of surgical method,type of onset,age of operation,epileptic site,course of disease and perioperative epileptic seizure on the surgical prognosis of children.Results Postoperative pathology showed that all the 56 cases both were FCDⅡb,in addition to the Transmantle sign,the MRI performance were also accompanied by focal blurring of gray and white matter,abnormal cortical structure,and abnormal signal foci in gray and white matter.Intraoperative EEG monitoring results showed that the epileptiform discharge area in all cases was larger than the lesion range showed by MRI.Postoperative Engel classification:25 cases of gradeⅠ(43.8%),18 cases of gradeⅡ(31.3%),4 case of gradeⅢ(6.3%),9 cases of gradeⅣ(18.8%).Surgical resection and perioperative seizures are independent factors affecting the prognosis of children(P<0.05).Conclusion surgical methods and perioperative seizures were closely related to the prognosis of children.

关 键 词：儿童 局灶性皮质发育不良 Tansmantle征 磁共振成像 外科手术 预后 

分 类 号：R742.1[医药卫生—神经病学与精神病学] R445.2[医药卫生—临床医学]