[1]郭强,朱丹,华刚.颞叶低级别肿瘤并顽固性癫痫的外科治疗策略[J].临床神经外科杂志,2015,(03):171-175.
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颞叶低级别肿瘤并顽固性癫痫的外科治疗策略()
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《临床神经外科杂志》[ISSN:1672-7770/CN:32-1727/R]

卷:
期数:
2015年03期
页码:
171-175
栏目:
癫痫专题 论著
出版日期:
2015-06-15

文章信息/Info

Title:
Surgical Stratagy of Temporal Lobe Epilepsy Associated with Low-Grade Tumor
作者:
郭强 朱丹 华刚
广东三九脑科医院
关键词:
脑肿瘤颞叶癫痫颅内电极导航
Keywords:
Brain Tumor Temporal Lobe Epilepsy Intracranial Electrodes Navigation
分类号:
R742.1
文献标志码:
A
摘要:
目的分析颞叶低级别肿瘤并癫痫的临床特点,并探讨其手术治疗策略。方法回顾2013年1月至2014年1月27例颞叶低级别肿瘤并癫痫患者的临床资料,分析其临床特点、手术切除策略及术后疗效。结果全组病变部位分布于颞叶外侧、颞叶内侧、颞叶底面、颞后等各个区域,少数累积到颞叶以外脑区。发作首发症状分别为精神体验先兆、植物神经先兆、视幻觉、愣神、失语、自动运动、复杂运动甚至全面性强直发作等。27例中,病变手术全切除5例,扩大切除20例,次全切除2例。全组病例术后无严重并发症。发作控制:所有患者术后随访1年以上,仅1例次全切除者为EngelⅡ级,其余26例(96.3%)均为EngelⅠ级。结论颞叶低级别肿瘤并顽固性癫痫视病变部位及所累及致痫网络的不同而发作首症状表现各异;对颞叶低级别肿瘤并顽固性癫痫,应行严谨的术前评估致痫区与肿瘤的关系,周密设计切除计划,在保障安全前提下尽可能全切肿瘤以及充分切除致痫区,必要时结合神经导航、术中唤醒皮层电刺激功能区定位或颅内电极等技术;手术后发作控制效果佳。
Abstract:
Objective To analysis the clinical characters of temporal lobe epilepsy (TLE) associated with low-grade tumor and explore a suitable surgical stratagy. Methods Retrospectively analysis surgical profiles of 27 cases of TLE associated with low-grade tumor from January, 2013 to January, 2014. ResultsThe lesions were located in lateral, mesial, basal, and posterior temporal lobe respectively, and a few were extended to extemporal lobe. The earliest seizure semiology include psychiatric aura, autonomic aura, visual hallucination, dialeptic, aphasia, automotor, complex motor, and even generalized tonic-clonic seizure. In 27 cases, 5 patients received total lesion resection, 20 patients underwent extensive resection, while 2 patients gained subtotal resection. No severe neural functional deficit was observed. Seizure control: After at least one year’s follow-up, except only one patient whose tumor wasn’t removed completely gained Engel Class Ⅱ, all 26 patients (96.3%) gained Engel Class Ⅰ.Conclusions TLE associated with low-grade tumor could show various seizure semiology as tumors locate in various part of temporal lobe and involve different epileptic network. Strict presurgical evaluation is needed to indentify relationship of tumor and epileptogenic zone, and to design suitable plan for thoroughresection of them in safety. When necessary, techniques such as neuronavigation, awake surgery, and intracranial electrodes implantation should be applied. Excellent seizure control can be achieved after surgery.

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备注/Memo

备注/Memo:
[收稿日期] 2015-03-31 [基金项目]广州市科技计划项目科技惠民专项
更新日期/Last Update: 2015-06-15