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目的探讨神经节细胞胶质瘤致癫的临床特点及手术疗效。方法回顾性分析手术治疗的17例神经节细胞胶质瘤致癫病例资料,观察发病年龄、病程、发作症状学、头皮脑电图、皮质脑电图、头颅MRI及手术方式等影响因素,术后癫按Engel标准评判。结果 17例肿瘤均全切除,并在术中脑电图监测指导下进行扩大切除(裁剪式病变切除7例,脑叶切除术10例),病理检查均为神经节细胞胶质瘤(WHOⅠ级)。7例病人出现并发症,其中视野缺损5例,对侧肢体远端感觉减退1例,记忆力减退1例。随访1.5~6年,随访期间癫控制均为EngelⅠ级,其中ⅠA级14例,ⅠC级3例(其中2例分别在术后第2个月和第4个月无诱因发作1次,1例术后2年高热后发作1次)。统计分析显示:仅“继发全面发作与否”对术后癫控制效果的影响有统计学差异(P=0.022)。结论神经节细胞胶质瘤致癫多为药物难治性,需手术治疗并可取得较好疗效。术前癫特点的综合评估有助于进一步提高手术疗效。
Objective To investigate the clinical characteristics and surgical treatment of epilepsy induced by ganglionic glioma. Methods The data of 17 cases of glioma induced by epilepsy of ganglion cells were retrospectively analyzed. The influencing factors such as age of onset, course of disease, symptomology, scalp EEG, cortical electroencephalogram, cranial MRI and operation mode were observed. Postoperative epilepsy according to Engel criteria. Results Totally 17 tumors were resected and enlarged under the guidance of intraoperative EEG monitoring (7 cases of excision and 10 cases of brain lobectomy). The pathological examination of the tumor was glioma of the ganglion (WHO grade Ⅰ ). Seven patients developed complications, including 5 cases of visual field defect, contralateral limb distal sensory loss in 1 case, memory loss in 1 case. Follow-up 1.5-6 years, during the follow-up of epilepsy control Engel Ⅰ level, including Ⅰ A grade 14 cases, Ⅰ C grade 3 cases (2 cases were in the first 2 months and 4 months after the onset of non-incentive 1, 1 Cases of hyperthermia 2 years after the onset of 1). Statistical analysis showed that the effect of postoperative epilepsy control was only statistically significant (P = 0.022). Conclusion Most of the ganglioglioma-induced epilepsy is drug refractory, requiring surgical treatment and obtaining good curative effect. A comprehensive assessment of the characteristics of preoperative epilepsy can help to further improve the efficacy of surgery.