颅内肿瘤切除前后皮层脑电图的变化对术后癫痫的预测价值

Predictive value of electrocorticography on postoperative epilepsy in patients with intracranial tumors

目的探讨皮层脑电图(electrocorticography,ECoG)在颅内肿瘤切除前后的变化特点及其对术后癫痫的预测价值。方法选择95例颅内肿瘤患者,于病灶切除前后进行ECoG监测,根据ECoG上多棘波密度、波幅变化分为术后痫性放电增多组(A组)、不变组(B组)及减少组(C组)。术后癫痫根据发生时间分为早期癫痫(术后1周内)与晚期癫痫(1周后)。随访4年,比较各组术后癫痫的发生率。结果95例颅内肿瘤患者病灶切除后ECoG显示A组13例(13.68%),B组37例(38.95%),C组45例(47.37%)。95例中术后早期癫痫32例(33.68%),分别为A组8/13例(61.54%)、B组13/37例(35.14%)、C组11/45例(24.44%),3组间比较差异有统计学意义(χ2=6.2,P<0.05);晚期癫痫17例(17.89%),A、B、C组分别为1/13例(7.69%)、7/37例(18.92%)、9/45例(20.00%),3组间比较差异无统计学意义(χ2=1.04,P>0.05)。32例早期癫痫中有7例(21.88%)出现晚期癫痫,63例术后无早期癫痫的病例中有10例(15.87%)出现晚期癫痫,二者比较差异无统计学意义(χ2=0.93,P>0.05)。结论颅内肿瘤切除前后的ECoG变化有助于预测术后早期癫痫。

Objective To explore predictive value of electrocorticography （ECoG） on postoperative epilepsy in patients with intracranial tumors. Methods Totally 95 patients with intracranial tumors were admitted in our hospital and their ECoG signals were recorded pre- and post-operation. According to the variation of the amplitude and density of spike waves on ECoG before and after operation, the patients were divided into 3 groups： group A who having more spike waves after tumors were removed, group B with the same amount and group C having lesser spike waves. The patients had a 4 years＇ follow-up and the epilepsy were divided into postoperative early epilepsy and late epilepsy. Results ECoG showed that the patients in group A, group B and group C separately were 13 cases （13.68%）, 37 cases （38.95%） and 45 cases （47.37%）. There were 32 patients with early epilepsy, and among them, 8 cases （61.54%）were from group A, 13 cases（35.14% ） from group B and 11 cases （24.44%） from group C. Significant difference was observed among the 3 groups with early epilepsy （ Chi-sqaure = 6.2, P 〈 0. 05）. Seventeen patients （ 17.89% ） who suffered late epilepsy were 1 （7.69%）, 7 （ 18.92% ） and 9 cases （20.00%） respectively in group A, group B, and group C （ Chi- sqaure = 1.04, P 〉 0. 05）. There are 7 patients of 32 patients with early epilepsy occurring late epilepsy, and 10 of 63 patients with no early epilepsy （ Chi-sqaure = 0.93, P 〉 0. 05）. Conclusion The variety of ECoG on patients with intracranial tumors undergone surgery is helpful to prognosticate postoperative early epilepsy.