摘要
目的探讨幕上肿瘤伴发癫痈的精确定位价值和手术治疗效果，研究肿瘤与致痢灶的关系。方法对121例（胶质瘤I级15例、Ⅱ级35例、Ⅲ～Ⅳ级12例，脑膜瘤32例，脑转移瘤10例，海绵状血管瘤15例，室管膜瘤2例）临床上以癫痈为首发症状的幕上肿瘤患者术前、术后癫痈发作情况等临床资料进行回顾性分析。结果采用术前影像和脑电结合定位、术中皮层脑电再次定位的方法，对肿瘤和癫痈灶同时切除，无手术死亡。癫痈发生率最高在额叶，最低在枕叶。癫痈灶与肿瘤的关系：位于同一部位者50例；致痈灶位于肿瘤一侧或近旁者28例；致痈灶位于肿瘤远隔部位（〉2cm）25例；检测不到致痫灶者18例。失访18例，103例随访1～9年，31例术后早期仍有小发作，83例不再服抗癫痈药物癫痈症状完全消除。结论在幕上肿瘤伴发癫痈患者中，致痈灶与肿瘤灶存在一定的差异性．．在开颅切除肿瘤的同时必须明确致痈灶的位置和范围、一并切除才能达到良好的手术效果。
Objective To study the value and effectiveness of surgical management and mapping in supratentorial tumoral complicated with epilepsy and to study the correlations between tumor and the epileptogenic focus. Methods The clinical data of 121 patients with supratentorial cerebral tumor but epilepsy as initial symptom were retrospectively analyzed for the incidence of pre- and postoperative epileptic seizures ,including grade Ⅰ glioma in 15 cases and grade Ⅱ glioma in 35 cases ,grade Ⅲ-Ⅳglioma in 12 cases ,menigoma in 32 eases ,metastases in 10 eases, cavernous angiomas in 15 cases,and ependymomas in 2 cases. Results Surgery based on CT/MRI,seizure type and EEG changes was conducted. There was no death in operation. The highest incidence was in frontal lobe and the lowest in occipital lobe. Correlations between localization of tumor and the epileptogenic focus ：there were 50 cases in the same location ,near or beside tumors in 28 cases,far separate apart （ 〉 2 cm） from tumors in 25 cases,no relationship was found in 18 cases. 103 patients were followed up for one to nine years. 31 patients had a few seizures in the early postoperative period. Epileptic seizures were cured without anti-epilepsy drugs in 83 cases. Conclusion There are some differences between tumors＇ location and epileptogenic focus in supratentorial tumoral epilepsy. The location and size of epileptogenic zone should be detected before and during operation. The resection of the tumor combined with the resection of the epileptogenic zone ＂epilepsy surgery＂ can provide good results.
出处
《中国综合临床》
北大核心
2008年第6期604-606,共3页
Clinical Medicine of China
关键词
幕上肿瘤
癫痫
外科手术
Supratentorial tumor
Epilepsy
Surgical operation
