Zhao Rui,Zhou Yuanfeng,Yang Haowei,et al.Clinical characteristics and surgical treatment of temporal lobe epilepsy in children.[J].Journal of Clinical Pediatric Surgery,2018,17(04):269-273.
儿童颞叶癫痫的临床特点及手术疗效分析
- Title:
- Clinical characteristics and surgical treatment of temporal lobe epilepsy in children.
- Keywords:
- Epilepsy; Temporal Lobe; Surgical Procedures; Operative; focal cortical dysplasia; Neoplasms; Child
- 文献标志码:
- A
- 摘要:
-
目的 探讨儿童难治性颞叶癫痫的特点及手术治疗效果。 方法 回顾性分析本院神
经外科收治并进行手术治疗的２５例儿童颞叶癫痫病例资料，对其年龄、侧别、脑电图特点、手术方式、病
理结果及手术疗效进行分析。 结果 本院自２０１２年６月至２０１６年９月共收治儿童颞叶癫痫患儿２５
例，男１４例，女１１例，平均年龄（６．５５±２．９８）岁（２～１２岁），左侧１１例，右侧１４例；术前平均口服２种
抗癫痫药物（１～３种），脑电图部分性发作２４例；全面性发作１例，表现为ＬｅｎｎｏｘＧａｓｔａｕｔ综合征；２５例
中，行颞前叶及海马杏仁核切除术６例，颞叶新皮层切除术４例，病灶切除术１２例，立体定向脑电图植
入（ＳＥＥＧ）术后再行切除３例；术后病理检查结果提示低级别肿瘤８例，局灶性皮层发育不良５例，海绵
状血管瘤２例，低级别肿瘤伴神经元变性及胶质增生（ＦＣＤⅢｂ）８例，海马硬化伴皮层发育不良（ＦＣＤⅢ
ａ）２例。无手术死亡病例，术后无出血、感染、脑积水等并发症。术后随访无新发语言及记忆损害，根据
谭启富教授术后分级标准，２１例术后疗效Ⅰ级（２１／２５），３例（３／１２）术后疗效Ⅱ级，１例（１／１２）术后疗
效Ⅲ级。不同手术方式对术后疗效无显著影响（Ｐ＞０．０５），但在皮层脑电监测下指导切除可获得更优
的癫痫控制效果（Ｐ＝０．０３４）。 结论 儿童颞叶癫痫不同于成人颞叶癫痫，主要以低级别肿瘤和局灶
性皮层发育不良为主，而非海马硬化。按照癫痫外科治疗原则，利用术中皮层脑电监测指导手术切除，
可以取得更好的癫痫控制效果。
- Abstract:
- ObjectiveTo explore the clinical characteristics and surgical treatment of intractable temporal lobe epilepsy in children.MethodsA retrospective review was performed for consecutive patients undergoing resection for temporal lobe epilepsy between June 2012 and September 2016.Such clinical characteristics as age,laterality,pathological findings,surgical approaches and seizure outcomes were analyzed.ResultsTwentyfive patients (14 boys,11 girls) with a mean age (±standard deviation) of 6.55±2.98 years (range:2-12 years) were included.The involved side was left (n=11) and right (n=14).Among 24 patients with partial seizures,1 case of generalized seizures was LennoxGastaut syndrome on scalp EEG.Resections included anterior temporal lobe and hippocampus amygdala (n=6),temporal neocortex (n=4),lesion (n=12) and surgery after stereotactic implantation of depth electrode (n=3).The major pathological findings included lowgrade glioma (n=8),focal cortical dysplasia (n=5),cavernous malformations (n=2),lowgrade glioma with cortical dysplasia (FCDⅢb) (n=8) and hippocampal sclerosis with cortical dysplasia (FCDⅢa) (n=2).There was no occurrence of such postoperative complications as bleeding,infection or hydrocephalus.No language or memory impairment was observed after operation.Twentyone patients remained seizurefree (21/25),seizure frequency decreased>75％(n=3,3/12) and <75％ (n=1,1/12).Different surgical approaches had no significant effect on postoperative curative efficacy (P>0.05).Better seizure control outcomes could be obtained under the guidance of electrocorticography (EcoG) monitoring (P=0.034).ConclusionTemporal lobe epilepsy in childhood is different from its adult counterpart.The most common abnormalities are lowgrade tumors and focal cortical dysplasia,but not hippocampus sclerosis.Intraoperative EcoG is a useful adjunct for ensuring a complete removal of epileptogenic zone and achieving optimal seizure freedom.
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