儿童癫痫相关性低级别神经上皮肿瘤的临床特点及手术疗效分析  

Analysis of clinical features and surgical outcomes of low-grade epilepsy-associated neuroepithelial tumors in children

作　　者：秦广彪[1,3] 马康平 易林华[1] 谭泊静[1] 陈倩[2] 姬辛娜[2] 冯硕[2] 高志杰[2] 毛莹莹[2] 张平平[2] 高彦彦 李云林 Qin Guangbiao;Ma Kangping;Yi Linhua;Tan Bojing;Chen Qian;Ji Xinna;Feng Shuo;Gao Zhijie;Mao Yingying;Zhang Pingping;Gao Yanyan;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;Department of Neurosurgery,Peking University People′s Hospital,Beijing 100044,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 [3]北京大学人民医院神经外科,北京100044

出　　处：《中华神经外科杂志》2023年第3期264-268,共5页Chinese Journal of Neurosurgery

摘　　要：目的探讨儿童癫痫相关性低级别神经上皮肿瘤(LEATs)的临床特点及手术疗效。方法回顾性分析2016年12月至2021年1月首都儿科研究所附属儿童医院神经外科采用手术治疗的46例LEATs患儿的临床资料。分析患儿的临床特点及手术疗效,比较肿瘤位于颞叶与非颞叶者、脑电图表现为非局灶性(全面性、弥漫性)放电与局灶性放电患者部分临床资料及手术疗效的差异。结果46例患儿中,病变位于颞叶者34例(73.9%),非颞叶者12例(26.1%);局灶性放电26例(56.5%),非局灶性放电20例(43.5%)。病理学结果显示,神经节细胞胶质瘤占73.9%(34例)。46例患儿均全切除肿瘤,术后均无永久性手术相关并发症。术后中位随访时间为35个月(12~60个月),术后3个月复查时,所有全面性或弥漫性脑电图放电均消失。至末次随访,均未见肿瘤复发;癫痫发作Engel分级Ⅰ级42例(91.3%)、Ⅱ级2例(4.3%)、Ⅳ级2例(4.3%)。肿瘤位于颞叶与非颞叶者比较,年龄、脑电图放电模式及术后Engel分级的差异均无统计学意义(均P>0.05),肿瘤位于非颞叶者行立体脑电图评估的比例高于颞叶者[4/12对比1/34(2.9%)],差异有统计学意义(P=0.018)。非局灶性放电者中0~6岁患儿的占比为80.0%(16/20),局灶性放电者中的0~6岁患儿占50.0%(13/26),差异有统计学意义(P=0.037);但两种放电模式的患儿术后Engel分级差异无统计学意义(P=0.422)。结论LEATs多位于颞叶;病理学种类多样,最常见的类型为神经节细胞胶质瘤;0~6岁儿童患者脑电图表现为全面或弥漫性放电的比例较高;患儿术后预后良好;病变部位及脑电图放电模式与癫痫手术效果无明显关系。Objective To explore the clinical features and surgical outcomes of low-grade epilepsy-associated neuroepithelial tumors(LEATs)in children.Methods A retrospective study was conducted in a single-center cohort of 46 child patients with LEATs who received surgery at the Department of Neurosurgery,Children′s Hospital Affiliated to Capital Institute of Pediatrics from December 2016 to January 2021.The clinical features and surgical outcomes of those children were analyzed,and the differences in some clinical data and surgical outcomes were analyzed between patients with tumors located in the temporal lobe and those with tumors in the extratemporal lobe and between patients with non-focal(generalized or diffusive)epileptic discharges and those with focal epileptic discharges.Results Among the 46 cases,34 cases(73.9%)had lesions in the temporal lobe and 12 cases(26.1%)had lesions in the extratemporal lobe;26 cases(56.5%)had focal epileptic discharges and 20 cases(43.5%)had non-focal epileptic discharges.The pathologic findings showed gangliogliomas in 34 cases(73.9%).At the 3-month follow-up,all generalized or diffusive epileptic discharges disappeared.With a median follow-up of 35(12-60)months,no tumor recurrence was found in the children at the last follow-up.In terms of seizures,42 cases(91.3%)had the outcome of Engel classⅠ,2(4.3%)reached Engel classⅡ,and 2(4.3%)reached Engel classⅣ.There were no significant differences in the age,electroencephalogram(EEG)pattern or postoperative Engel class between the temporal lobe group and extratemporal lobe group(all P>0.05).The proportion of stereoelectroencephalogram(SEEG)evaluation in patients with tumors located in the extratemporal lobe was higher than that in patients with tumors located in the temporal lobe[4/12 vs.1/34(2.9%)],and the difference was statistically significant(P=0.018).The proportion of young children(0-6 years old)in patients with non-focal discharges was higher than that in patients with focal discharges[80.0%(16/20)vs.50.0%(13/26)](P=0.037).How

关 键 词：癫痫 脑肿瘤 儿童 疾病特征 神经外科手术 治疗结果 

分 类 号：R739.4[医药卫生—肿瘤]