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目的探讨儿童脑肿瘤继发性癫的临床特征。方法回顾性分析38例脑肿瘤继发癫病儿的临床资料,包括致脑肿瘤的生长部位、病理类型、癫发作类型、脑电图表现、手术治疗方式以及预后等。结果引起癫发作的儿童脑肿瘤主要来源于额叶和颞叶,而顶叶、枕叶、岛叶相对少见(P<0.05)。病理类型以神经元和混合性神经元-胶质肿瘤多见,其次为少突胶质细胞瘤。额叶肿瘤主要引起全身强直-阵挛性发作,颞叶肿瘤以复杂部分性发作为主,二者有显著差异(P<0.05)。头皮脑电图异常主要表现为尖波或尖-慢波。手术方式以肿瘤全切加致灶切除为主,术后随访3~15个月,治愈32例,肿瘤复发4例,死亡2例。术后癫控制达到EngelⅠ级28例,EngelⅡ~Ⅳ级8例。结论儿童继发性癫发作的脑肿瘤以良性肿瘤为主,治疗策略应早期行肿瘤加致灶切除手术,临床预后较好。
Objective To investigate the clinical characteristics of secondary brain tumors in children with epilepsy. Methods The clinical data of 38 children with epilepsy with brain tumor were analyzed retrospectively. The results included the growth site, pathological type, epileptic seizure type, EEG appearance, surgical treatment and prognosis. Results Brain tumors in children with epileptic seizures mainly originated from the frontal and temporal lobes, while the parietal, occipital and insular lobes were relatively rare (P <0.05). Pathological types of neurons and mixed neurons - glial tumors more common, followed by oligodendroglial tumors. Frontal lobe tumors mainly cause systemic tonic - clonic seizures, temporal lobe tumors with complex partial seizures, the two were significantly different (P <0.05). Scalp EEG abnormalities mainly as spikes or sharp - slow wave. Surgical treatment of total excision of the tumor led to abdomen, followed up for 3 to 15 months, 32 cases were cured, 4 cases of tumor recurrence, and 2 deaths. Postoperative epilepsy control reached Engel Ⅰ grade in 28 cases, Engel Ⅱ ~ Ⅳ grade in 8 cases. Conclusions Children with secondary epileptic seizures are mainly benign tumors. Tumor resection should be performed in early stage with excision of the tumor. The clinical prognosis is good.