摘要
目的探讨局灶性皮质发育不良(FCD)相关"难定位"难治性癫痫患者的手术疗效及相关影响因素。方法选择福建医科大学附属第一医院神经外科自2011年1月至2018年12月经颅内脑电图(iEEG)评估后行手术治疗的35例FCD相关"难定位"难治性癫痫患者作为研究对象,采用Engel分级标准评估手术疗效,将患者分为疗效完全满意组(EngelⅠ级)和疗效不完全满意组(EngelⅡ~Ⅳ级)。比较2组患者的临床资料,采用多因素Logistic回归分析确定FCD相关"难定位"难治性癫痫患者术后疗效的独立影响因素。结果术后疗效完全满意26例(74.3%),疗效不完全满意9例(25.7%)。与疗效完全满意组比较,疗效不完全满意组患者的致痫灶完全切除率较低,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,致痫灶不完全切除为"难定位"难治性癫痫的手术疗效的独立影响因素(P=0.014,OR=0.050,95%CI:0.005~0.547)。结论FCD相关"难定位"难治性癫痫患者经iEEG监测定位致痫灶后手术切除可获得满意疗效。致痫灶不完全切除患者手术疗效较差。
Objective To explore the surgical outcomes of focal cortical dysplasia(FCD)patients with"difficult to locate"intractable epilepsy and their influencing factors.Methods Thirty-five FCD patients with"difficult to locate"intractable epilepsy,underwent surgical treatment after intracranial electroencephalogram(iEEG)evaluation in our hospital from January 2011 to December 2018,were chosen in our study.Engel grading was used to evaluate the surgical efficacies of these patients,and they were divided into a satisfied efficacy group(Engel grading I)and an incomplete satisfied efficacy group(Engel grading II-IV).The clinical data of patients from the 2 groups were compared.Multivariate Logistic regression analysis was performed to explore the influencing factors for surgical outcomes of FCD patients with"difficult to locate"intractable epilepsy.Results Of these 35 patients,26 patients(74.3%)achieved satisfied efficacy,and 4 had incomplete satisfied efficacy.As compared with those in the satisfied efficacy group,patients in the incomplete satisfied efficacy group had significantly lower total resection rate of epileptogenic foci(P<0.05).Multivariate Logistic regression analysis showed that incomplete resection of epileptogenic foci was the influencing factor for surgical outcomes of FCD patients with"difficult to locate"intractable epilepsy(P=0.014,OR=0.050,95%CI:0.005-0.547).Conclusion The FCD patients with"difficult to locate"intractable epilepsy can achieve satisfactory results by surgical resection of epileptogenic zones after iEEG monitoring;these FCD patients with"difficult to locate"intractable epilepsy with incomplete resection of epileptogenic foci often have poor surgical outcomes.
作者
李承俊
王丰
姚培森
许明霞
余良宏
康德智
林元相
Li Chengjun;Wang Feng;Yao Peisen;Xu Mingxia;Yu Lianghong;Kang Dezhi;Lin Yuanxiang(Department of Neurosurgery,First Affiliated Hospital of Fujian Medical University,Fuzhou 350005,China)
出处
《中华神经医学杂志》
CAS
CSCD
北大核心
2021年第8期793-798,共6页
Chinese Journal of Neuromedicine
基金
福建省科技创新联合资金项目(2019Y9121、2019Y9123)。
关键词
癫痫
局灶性皮质发育不良
颅内脑电图
手术预后
Epilepsy
Focal cortical dysplasia
Intracranial electroencephalogram
Surgical outcome
