论文部分内容阅读
目的探讨MRI阳性癫患儿手术预后的相关因素。方法回顾分析2005年6月-2009年9月在本院经手术治疗并能进行1 a以上随访的58例MRI阳性癫患儿资料。根据术前视频脑电图(VEEG)、MRI、正电子发射计算机断层显像和计算机断层扫描(PET-CT)、侵入性脑电图(IEEG)等评估结果确定致灶部位和手术方案。手术中尽可能全切病灶和致灶。根据Engel分级法将患儿分为未见发作组(Engel等级Ⅰ级)与有发作组(Engel等级Ⅱ～Ⅳ级),对可能影响手术预后的因素包括手术年龄、病程、首发年龄、发作频率、发作类型、致灶部位、MRI与VEEG定位一致性等进行统计分析。结果 39例(67.2%)MRI阳性癫患儿未见发作。其中17例(73.9%)颞叶萎缩或海马硬化,11例(91.7%)低级别肿瘤,4例(66.7%)蛛网膜囊肿,3例(42.9%)皮质发育不良,2例(100%)海绵状血管瘤,2例(25.0%)软化灶。在术后有发作的19例患儿中,4例(6.9%)极少发作,7例(12.1%)为En-gelⅢ级,8例(13.8%)为EngelⅣ级。病程短、非继发全面性发作类型、发作频率低、MRI与VEEG定位一致的MRI阳性癫患儿手术效果好。手术年龄、首发年龄、致灶部位与癫患儿手术效果无明显相关。结论 MRI阳性癫患儿手术效果良好,对MRI阳性癫患儿应早期手术治疗。根据患儿在手术治疗过程中的临床因素及诊断结果等可以对手术效果进行预测。
Objective To investigate the related factors of prognosis in children with MRI-positive epilepsy. Methods The data of 58 children with MRI-positive epilepsy who underwent surgery and who were followed up more than 1 year in our hospital from June 2005 to September 2009 were retrospectively analyzed. According to VEEG, MRI, positron emission computed tomography and computed tomography (CT-PET), invasive electronechogram (IEEG) and other assessment results to determine the site of the lesions and surgery plans. Surgery as possible to cut the whole lesion and caused by stovepipe. According to the Engel grading method, the children were divided into two groups: Engel grade Ⅰ and Engel grade Ⅱ ~ Ⅳ. Factors that may affect the prognosis of the surgery included age of operation, duration of disease, age at onset, frequency of seizure , Type of seizures, lesions caused by the stove, MRI and VEEG positioning consistency statistical analysis. Results There were no seizures in 39 cases (67.2%) with MRI-positive epilepsy. Seventeen patients (73.9%) had atrophy of the temporal lobe or hippocampus, 11 (91.7%) low grade tumors, 4 (66.7%) arachnoid cysts, 3 (42.9%) cortical dysplasia, 2 (100% Cavernous hemangioma, 2 cases (25.0%) of the soft focus. Of the 19 patients who developed postoperative seizures, 4 (6.9%) seldom had seizures, 7 (12.1%) were En-gel grade III and 8 (13.8%) were Engel grade IV. Short duration, non-secondary type of comprehensive attack, seizure frequency is low, MRI and VEEG consistent positioning of MRI-positive children with epilepsy surgery effect. There was no significant correlation between surgical site and initial onset of age in children with epilepsy. Conclusion The results of surgery in children with MRI-positive epilepsy are good. Early surgical treatment of children with MRI-positive epilepsy should be performed. According to the children in the surgical treatment of clinical factors and diagnostic results can predict the effect of surgery.