立体定向脑电图引导下射频热凝治疗儿童下丘脑错构瘤的疗效分析  

Clinical efficacy for stereotactic-electroencephalography-guided radiofrequency thermocoagulation treatment of hypothalamic hamartoma in children

作　　者：刘云云[1] 王军[1] 樊晓彤[1] 王逸鹤[1] 周天 单永治[1] Yunyun Liu;Jun Wang;Xiaotong Fan;Yihe Wang;Tian Zhou;Yongzhi Shan(Department of Neurosurgery,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院神经外科,北京100053

出　　处：《中华神经创伤外科电子杂志》2024年第3期158-163,共6页Chinese Journal Of Neurotraumatic Surgery:Electronic Edition

基　　金：首都卫生发展科研专项基金(首发2022⁃1⁃8011)

摘　　要：目的分析立体定向脑电图(SEEG)引导下射频热凝(SEEG RF-TC)治疗儿童下丘脑错构瘤(HH)的临床效果。方法回顾性分析首都医科大学宣武医院神经外科自2015年7月至2020年11月收治的42例HH患儿的临床资料。所有患儿经癫痫外科术前评估后行SEEG电极置入术,完成脑电图监测后行SEEG RF-TC治疗。出院后3、6、12、24个月定期随访,观察SEEG RF-TC的治疗效果及随访结果。按照末次随访结果将患儿分为治愈组和非治愈组,比较2组患儿术后并发症(中枢热、尿崩、电解质紊乱)发生情况,分析HH预后与术后下丘脑反应的相关性。结果42例患儿中,34例患儿治愈(治愈组),8例患儿未治愈(非治愈组),术后癫痫无发作率为81.0%,癫痫缓解率为92.9%。2组患儿术前一般资料比较,差异无统计学意义(P>0.05)。42例患儿术后中枢性高热发生率42.9%,电解质紊乱发生率4.8%,尿崩症发生率4.8%,多为一过性反应。治愈组和非治愈组患儿的中枢性高热发生率比较,差异有统计学意义(P<0.05),尿崩症、电解质紊乱、药物降温比较,差异无统计学意义(P>0.05)。Spearman相关性分析显示,HH预后与中枢性高热显著相关(r=0.315,P<0.05)。结论SEEG RF-TC治疗HH患儿安全有效,术后严密监测中枢性高热等下丘脑反应问题,有助于患儿安全度过围术期,改善预后。Objective To analyze the clinical efficacy of stereotactic-electroencephalography-guided radiofrequency thermocoagulation(SEEG RF-TC)in the treatment of hypothalamic hamartoma(HH)in children.Methods A retrospective analysis was conducted on the clinical data of 42 children with HH admitted to Neurosurgery Department of Xuanwu Hospital,Capital Medical University from July 2015 to November 2020.All patients underwent stereotactic electroencephalography(SEEG)electrode placement after preoperative evaluation in epilepsy surgery.After completing EEG monitoring,SEEG RF-TC treatment was administered.Regular follow-up visits were conducted at 3,6,12,and 24 months after discharge to observe the therapeutic effect and follow-up results of SEEG RF TC.According to the last follow-up results,the children were divided into a cured group and a non-cured group.The incidence of postoperative complications(central fever,diabetes insipidus,electrolyte imbalance)was compared between two groups,and the correlation between HH prognosis and postoperative hypothalamic response was analyzed.Results Among the 42 patients,34 patients were cured(cured group),and 8 patients were not cured(non-cured group),the postoperative seizure free rate was 81.0%,and the epilepsy remission rate was 92.9%.There was no statistically significant difference in preoperative general information between the two groups of patients(P>0.05).Among 42 patients,the incidence of central hyperthermia after surgery was 42.9%,electrolyte imbalance was 4.8%,and diabetes insipidus was 4.8%,mostly a transient reaction.There was a statistically significant difference in the incidence of central hyperthermia between the cured and non-cured groups(P<0.05),while there was no statistically significant difference in the incidence of diabetes insipidus,electrolyte imbalance,and drug cooling(P>0.05).Spearman correlation analysis showed that the prognosis of HH was significantly correlated with central hyperthermia(r=0.315,P<0.05).Conclusion SEEG RF-TC treatment is safe and effectiv

关 键 词：下丘脑错构瘤 立体定向脑电图 射频热凝术 痴笑发作 中枢性高热 

分 类 号：R739.4[医药卫生—肿瘤]