摘要
目的:探讨颞叶肿瘤伴癫痫的手术治疗策略和预后评估措施。方法:应用脑电图、CT、MRI等确定病灶及致痫灶,并应用事件相关电位及韦氏智力量表评估认知功能。共48例,以Labbe静脉为界分为前颞叶癫痫组和后颞叶癫痫组,分别经翼点入路和颞枕瓣入路行病灶及痫灶切除,术中行皮层脑电图监测。术后随访,结合手术切除情况、术后癫痫Engle分级和认知功能变化综合评价治疗效果。结果:术前患者均存在认知损害,病灶及致痫灶均准确定位。17例行病灶或/和周围异常放电组织切除,31例行较广泛病灶切除或病灶切除+软脑膜热灼或多处软膜下横切术。肿瘤全切除37例,近全切除8例,大部切除3例。术后平均随访1.9年,随访期内死亡3例。术后认知损害较术前有显著改善,二者认知功能各指标比较差异有统计学意义(P<0.05);癫痫Engle分级,I级34例(70.8%),Ⅱ级8例(16.7%),Ⅲ级4例(8.3%),IV级2例(4.2%)。肿瘤全切除者癫痫均获控制(100%),其中9例(24.3%)存在认知损害;11例部分切除者有6例(54.5%)癫痫控制差且8例(72.7%)存在认知损害。结论:对颞叶肿瘤伴癫痫,切除病灶和控制癫痫同等重要。术前准确定位、选择恰当的手术入路和手术方法进行病灶及痫灶切除是获得较好预后的有效途径。认知功能是评价手术效果的指标之一。
Objective：To study the surgical treatment and outcome of 48 patients with tumor-related temporal lobe epilepsy （TLE）. Methods：Lesion（tumor） and epileptic focus were located by EEG, CT and MRI, and cognitive ability were evaluated by cognitive event related potential and WAIS-RC. All patients were divid al of into anterior and posterior temporal epilepsy with Labbe vein as the line of demarcation. Through pterion approach and temporal-occipital approach, the surgical treatment including lesionectomy and removal of epileptic focus were performed and monitor ed by introperative electrocorticogram. The effect of operations was evaluated by state of resection, the Engle scale of epilepsy and in combination with cognitive ability at follow-up period. Results： Before operations, all patients had cognitive impairment, and lesion and epileptic focus were accurately located. Lesionectomy and/or removed epileptogenic areas adjacent to the tumor in 17 cases and lesionectomy, lesionectomy plus callosotomy, or multiple subpial transection in 31 cases were performed. Total tumor resection was achieved in 37 cases, subtotal resection in 8 cases,and gross resection in 3 cases. During a median follow-up of 1.9 years, compared with markers of the cognitive ability, it had significant difference between pre- and post- operation （P〈 0.05）. According to Engle standard of the curative effect, grade Ⅰ accouted for 70.8%, grade Ⅱ 16.7%,grade Ⅲ 8.3% and grade Ⅳ 4.2%, respectively. The epilepsy was controled and cognitive impairment was improved in patients with total tumor resection. Conclusion：It is tqually important to perform lesionectomy and to remove epileptic focus in patients with TLE that may provide good seizure control and improv cognitive ability.Accurate location of lesion and epileptic focus before operation, and selection of appropriate operation approach and surgical methods is an effective way to obtain good outcome. The evaluation of cognitive ability is a marker of surgical outcome.
出处
《泸州医学院学报》
2008年第5期538-541,共4页
Journal of Luzhou Medical College
关键词
脑肿瘤
颞叶
癫痫
外科手术
预后
Brain tumor
Temporal lobe
Epilepsy
Surgical treatment
Prognosis
