神经节细胞胶质瘤伴癫痫21例临床分析

Clinical Research of Ganglioglioma with Epilepsy(21 Cases Report)

目的分析神经节细胞胶质瘤并癫痫的临床特点及影响发作控制结果的因素,并探讨其手术治疗策略。方法回顾2007年至2010年间21例神经节细胞胶质瘤并癫痫患者的临床资料,并统计分析各因素对发作控制结果的影响。结果 21例中,病变手术全切除17例,大部切除4例。10例联合癫痫灶处理。术后3例肢体轻偏瘫,1例部分性视野缺损。发作控制:EngleⅠ级15例,Ⅱ级4例,Ⅲ级1例,Ⅳ级1例。术后无发作(EngleⅠ级)与性别、病变是否全切相关,而与起病年龄、病程、发作类型、是否位于颞叶、是否难治性、病理级别、手术方式(单纯切除还是结合癫痫灶处理)等无明显相关性。结论对神经节细胞胶质瘤伴癫痫患者,应在保障安全前提下尽可能全切,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,对顽固性癫痫应同时处理癫痫灶;神经节细胞胶质瘤手术后发作控制相对良好。

Objective The aim of this study is to analysis the clinical features of gangliogliomas accompanied by epilepsy,and to evaluate various clinical and surgical factors contributing to seizure outcomes,and to explore surgical methods for treating them.Methods We analyze retrospectively the clinical profiles of 21 patients with gangliogliomas accompanied by epilepsy during 2007 to 2010,and analyze statistically factors that may affect seizure outcomes.Results Seventeen cases underwent gross total removal and 4 cases underwent subtotal resection.Ten of those patients had epileptic focus treated at the same time.Three patients had hemiparesis and one had hemianopia postoperatively.Seizure outcome： 15 cases are of Engel class Ⅰ,4 cases class Ⅱ,1 case class Ⅲ and 1 case class Ⅳ.The factors of gender and gross total removal or not were signi？cantly correlated with seizure free,while onset age,symptom duration,type of seizure,being in temporal lobe or not,being refractable or not,pathology,type of operation（purely lesion resection or associated with epileptic focus treatment） etc.were not.Conclusion For ganglioglioma with epilepsy,when safety can be guaranteed,doctors should totally remove it as possible as they can.Neuronavigation,intraoperative wake-up and functional mapping by cortical electrical stimulation,or intracranial electrodes can be applied when necessary.For patients with refractable epilepsy,epileptic focus should be treated as well.After surgery of gangliogliomas the seizure outcome is relatively good.