脑瘫伴顽固性癫痫患者大脑半球切除术前后影像学改变研究

Change in Craniocerebral Images before and after Hemispherectomy in Patients with Cerebral Palsy and Intractable Epilepsy

目的研究脑瘫伴顽固性癫痫患者改良的大脑半球切除术前后颅脑的影像学变化,分析大脑的可塑性。方法测量20例正常受试者和20例经改良的大脑半球切除术治疗的脑瘫伴顽固性癫痫患者术前3～10d和术后3～4年的大脑脚底截面积、健侧大脑半球的面积、患侧额窦的面积、患侧颅骨的厚度、术后手术残腔的面积及头围,并进行比较分析。结果患者手术前后健侧大脑脚底截面积明显大于正常人(P<0.05),而患侧则明显小于正常人(P<0.05);患者患侧以及健侧大脑脚底截面积手术前后相比则无明显差异(P>0.05),术前与术后健侧大脑半球面积、患侧额窦截面积、颅骨厚度、残腔截面积均有显著差异(P<0.01)。结论脑瘫伴顽固性癫痫患者大脑半球切除后功能代偿的同时有解剖形态结构的代偿,功能和解剖结构的代偿性是相一致的。

Objective To study the change in the craniocerebral image before and after hemispherectomy and cerebral plasticity in the patients with cerebral palsy and intractable epilepsy. Methods The cross section areas of cerebral peduncles,operative residual cavity,cerebral hemisphere contralateral to the operation,and frontal sinus ipsilateral to the operation,the thickness of cranial skull ipsilateral to the operation and head circumference were measured on CT and MR images in 20 patients with cerebral palsy and intractable epilepsy from 3 to 10 days before and from 3 to 4 years after the improved hemipherectiomy. Twenty healthy subjects served as control. Results The pre-and post-operative cross secion areas of cerebral peduncles contralateral to the operation were significantly bigger in the patients with cerebral palsy than that in the healthy subjects （P〈0.05）,and ones of their cerebral peduncles ipsilateral to the operation were significantly smaller than that in the healthy subjects （P〈0.05）. There were significant differences in the cross section areas of cerebral hemisphere contralateral to the operation,residual cavity,and frontal sinus ipsilateral to the operation,and the thickness of cranial skull ipsilateral to the operation before and after the operation （P〈0.01）. Conclusion The functional and morphological compensation can appear early or late after the hemispherectomy in the patients with cerebral palsy.