[1]华刚,谭红平,张立民,等.Rasmussen脑炎的诊断与手术治疗[J].临床神经外科杂志,2018,15(04):287-291.
 HUA Gang,TAN Hong-ping,ZHANG Li-min,et al.Diagnosis and surgical treatment of Rasmussen encephalitis[J].Journal of Clinical Neurosurgery,2018,15(04):287-291.
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Rasmussen脑炎的诊断与手术治疗()
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《临床神经外科杂志》[ISSN:1672-7770/CN:32-1727/R]

卷:
15
期数:
2018年04期
页码:
287-291
栏目:
论著
出版日期:
2018-08-15

文章信息/Info

Title:
Diagnosis and surgical treatment of Rasmussen encephalitis
作者:
华刚谭红平张立民郭强朱丹
510510 广州,广东三九脑科医院癫痫中心癫痫外科
Author(s):
HUA GangTAN Hong-pingZHANG Li-minet al.
Department of Epilepsy Surgery in Guangdong Sanjiu Brain Hospital,Guangzhou 510510,China
关键词:
Rasmussen脑炎显微外科手术解剖式大脑半球切除术
Keywords:
Rasmussen encephalitismicrosurgeryanatomical hemispherectomy
分类号:
R512.3
文献标志码:
A
摘要:
目的 探讨Rasmussen脑炎的诊断和手术治疗。方法 回顾性分析广东三九脑科医院2014年4月至2017年6月,经手术治疗及病理检查证实的5例Rasmussen脑炎患者的临床资料;并复习相关文献。结果 本组患者的临床表现为单侧大脑半球皮层炎症、药物难治性癫痫及进展性神经功能和认知功能损害。最具特征性的表现为进展性局部脑皮层萎缩和部分性癫痫发作持续状态(EPC)。癫痫发作的类型多样,但EPC发作一般不继发全面性强直阵挛发作。脑电图表现无特异性,为患侧广泛性慢波、棘-慢波,甚至波及对侧。MRI典型表现为T2FLAIR局灶性皮层及皮层下、尾状核头部高信号,并且病灶可以随着病程延长不同程度的扩大。PET检查表现为较局灶性病灶明显扩大的低代谢范围。本组患者均经侧裂入路行解剖式大脑半球切除术,包括岛叶皮层切除。术后随访8个月至3年,患者的癫痫发作均得到完全控制,神经功能损害均较术前有不同程度恢复。结论 根据好发年龄及典型临床表现,结合影像学检查,Rasmussen脑炎的诊断不难。积极采取合理的治疗方法,特别是外科大脑半球切除术,患者能获得良好的疗效。
Abstract:
Objective To explore the diagnosis and surgical treatment of Rasmussen encephalitis.Methods The clinical data of 5 patients with pathologically confirmed Rasmussen encephalitis who underwent surgery in our hospital from April 2014 to June 2017 were analyzed retrospectively and the related literatures were reviewed.Results The clinical manifestations of Rasmussen encephalitis were unilateral hemisphere cortical inflammation,drug refractory epilepsy and progressive neurological and cognitive impairment.The most characteristic manifestation was progressive local cortical atrophy and partial seizure persistence (EPC).There were many types of seizures,but EPC did not evolve to Global tonic-clonic seizure.EEG manifested the general ipsilateral broad-wave slow,spike slow wave which even spread to the contralateral,but had non-specific performance.MRI typical performance of T2FLAIR was high signal of focal cortical,subcortical and caudate nucleus head,which even can be extended with the progress of disease.PET examination showed low metabolism in one side of the hemisphere which exceeded the lesion range.This group of patients all underwent anatomical hemispherectomy by the lateral fissure approach,including the insular cortex resection.The follow-up from 8 months to 3 years showed the seizures were completely controlled and neurological dysfunction was recovered to varying degrees compared with pre-operation.Conclusions It is not difficult to diagnosis Rasmussen encephalitis,according to the illness age and typical clinical manifestations,combined with imaging examination.Reasonable surgical treatment can get good results,especially surgical hemispherectomy.

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更新日期/Last Update: 1900-01-01