颅脑外科手术前后继发性癫痫186例临床分析

The relationship of secondary epilepsy and craniocerebral operations:a clinical analysis of 186 cases

目的探讨颅脑外科手术前后继发性癫痫的临床特点及其与手术的关系。方法对186例颅脑外科手术相关继发性癫痫患者的临床资料进行回顾性分析,其中术前癫痫组(A组)90例,为行颅脑外科手术治疗之前就伴有癫痫的患者,术后癫痫组(B组)96例,为行颅脑外科手术后继发癫痫的患者。分别对A、B组患者的原发病因、病灶及癫痫发作类型进行统计。结果A组和B组患者居前两位的原发病因分别是脑肿瘤、脑血管畸形和颅脑外伤、神经系统肿瘤。经头颅CT或MRI检查证实,A、B两组患者的致痫灶均以额叶(分别为31.8%和29.5%)、颞叶(30.7%和26.3%)和顶叶(17.0%和24.2%)为主。A组手术前后癫痫发作类型的构成未发生明显改变(χ2=0.2143,P=0.6434),但术后癫痫发作频率较术前减少(χ2=11.3133,P=0.0101),B组发作频率较术前增加(χ2=77.0803,P=0.0000)。A组术后局灶性脑电活动异常的例数较术前减少(χ2=9.7734,P=0.0075);B组术后脑电异常活动的例数也有增加,但与术前相比无统计学差异(χ2=4.3660,P=0.1127)。结论颅脑手术可以有效治疗继发性癫痫,但也是导致临床继发性癫痫发作的明确原因之一。颅脑手术不会导致脑电异常活动的显著增加。

Objective To evaluate the clinical features in patients with pre- or post-operation epilepsy, and to explore the relationship of secondary epilepsy and craniocerebral operations. Methods The patients involved in present study were admitted and underwent the craniocerebral operations in the General Hospital of PLA from Jun. 1999 to Feb. 2008. The clinical data of epilepsy occurred at pre- or post- operation were retrospectively analyzed. All the 186 patients were divided into the pre-operation epilepsy group（Group A, n=90 ） and the post-operation epilepsy group（Group B, n=96）. Based on a standardized questionnaire, a database was established with Microsoft Access 2007 including the primary etiological factor, the location of epileptogenic focus, the seizure frequency, the seizure type, and the abnormal electroencephalogram （EEG）. Results Intracranial tumor and cerebrovascular malformation were the main primary etiological factors in group A, and intracranial tumor, cerebral trauma, cerebrovascular malformation and acute cerebral apoplexy were the main primary etiological factors in group B. The four main primary etiological factors for seizures were discovered in significant difference between group A and group B（χ^2 = 45. 857 3, P=0. 000 0）. Cranial computed tomography（CT） or nuclear magnetic resonance imaging（MRI） detected that the most locations of epileptogenic focus were in frontal lobe（31.8% in group A and 29. 5% in group B）, temporal lobe（30. 7% in group A and 26. 3% in group B）, and parietal lobe（17. 0% in group A and 24. 2% in group B）. The frequency of seizure was significantly decreased in group A（ χ^2 = 11. 313 3, P=0. 010 1）, and was increased in group B（χ^2=77. 080 3, P=0. 000 0）. The quantity of abnormal EEG for focal epilepsy was significantly decreased in group A（χ^2 =9. 773 4, P=0. 007 5）, but the increasing quantity of abnormal EEG was not significant in group B（χ^2 =4. 366 0, P=0. 112 7）. No significant difference in seizure type was proved after the craniocerebral operations in group A（χ^2 =0. 214 3, P=0. 643 4）. Campared with the post-operation epilepsy group, the location of epileptogenic focus did not show significant distinction in the pre-operation epilepsy group（χ^2 =1. 772 2, P=0. 777 6）. Conclusions Craniocerebral operation is an effective therapy for the secondary epilepsy with certain epileptogenic focus, and it is one of the definite causes of secondary epilepsy.