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目的探讨以癫痫起病的颞叶胶质瘤的临床特征、显微治疗方式及效果。方法选择22例以癫痫起病的颞叶胶质瘤患者,其中男性16例,女性6例;年龄5~52岁,平均年龄31.1岁。术前进行MRI、24 h视频脑电图(VEEG)和发作间期正电子发射断层摄影术(PET)等检查,综合评估制定手术方案,同时结合术中皮层电极描记(ECo G)探查异常放电确定致痫灶切除范围,对患者临床资料、病理结果、手术方式和手术效果进行回顾性分析。结果 22例患者均行显微手术肿瘤全切,其中7例行单纯病变切除;15例存在额外异常放电区域加行致痫灶切除。病理组织检查提示病变以低级别胶质瘤为主,部分病例合并颞叶内侧结构硬化改变。术后随访1~2年,患者癫痫缓解率满意,未见肿瘤复发。结论对颞叶胶质瘤继发癫痫患者,术前积极评估,采取个体化手术方案,争取肿瘤显微全切,同时恰当处理致痫灶,是抑制肿瘤复发和控制癫痫发作的有效手段。
Objective To investigate the clinical characteristics of temporal lobe glioma with onset of epilepsy, microsurgical treatment and its effects. Methods Twenty-two patients with temporal lobe gliomas with epilepsy onset were selected, including 16 males and 6 females, ranging in age from 5 to 52 years with a mean age of 31.1 years. Preoperative MRI, 24 h video EEG (VEEG) and interictal positron emission tomography (PET) and other tests, comprehensive evaluation of the development of surgical options, combined with intraoperative cortical electrode mapping (ECo G) to detect abnormal discharge To determine the extent of resection of epileptogenic lesions, the clinical data of patients, pathological findings, surgical methods and surgical effects were retrospectively analyzed. Results Twenty-two patients underwent microsurgical total tumor resection. Seven patients underwent simple excision. Fifteen patients had additional abnormal discharge and epileptogenic resection. Histopathological examination showed that the lesion was mainly low-grade glioma, and some cases were complicated by structural changes of the medial temporal lobe. Follow-up 1 to 2 years after surgery, patients with satisfaction rate of epilepsy, no tumor recurrence. Conclusions The positive preoperative assessment of patients with temporal lobe glioma secondary to epilepsy is an effective means of inhibiting tumor recurrence and controlling epileptic seizures by taking individualized surgical protocols and attempting to obtain tumor microdissection while properly treating epileptogenic lesions.