磁共振成像阳性癫患儿手术效果及其预后因素

Surgery Outcome and Its Prognostic Factors in Child Epilepsy with Magnetic Resonance Imaging-Positive

目的探讨MRI阳性癫患儿手术预后的相关因素。方法回顾分析2005年6月-2009年9月在本院经手术治疗并能进行1 a以上随访的58例MRI阳性癫患儿资料。根据术前视频脑电图(VEEG)、MRI、正电子发射计算机断层显像和计算机断层扫描(PET-CT)、侵入性脑电图(IEEG)等评估结果确定致灶部位和手术方案。手术中尽可能全切病灶和致灶。根据Engel分级法将患儿分为未见发作组(Engel等级Ⅰ级)与有发作组(Engel等级Ⅱ～Ⅳ级),对可能影响手术预后的因素包括手术年龄、病程、首发年龄、发作频率、发作类型、致灶部位、MRI与VEEG定位一致性等进行统计分析。结果 39例(67.2%)MRI阳性癫患儿未见发作。其中17例(73.9%)颞叶萎缩或海马硬化,11例(91.7%)低级别肿瘤,4例(66.7%)蛛网膜囊肿,3例(42.9%)皮质发育不良,2例(100%)海绵状血管瘤,2例(25.0%)软化灶。在术后有发作的19例患儿中,4例(6.9%)极少发作,7例(12.1%)为En-gelⅢ级,8例(13.8%)为EngelⅣ级。病程短、非继发全面性发作类型、发作频率低、MRI与VEEG定位一致的MRI阳性癫患儿手术效果好。手术年龄、首发年龄、致灶部位与癫患儿手术效果无明显相关。结论 MRI阳性癫患儿手术效果良好,对MRI阳性癫患儿应早期手术治疗。根据患儿在手术治疗过程中的临床因素及诊断结果等可以对手术效果进行预测。

Objective To investigate the surgery outcome of children epilepsy with magnetic resonance imaging（MRI）-positive,and prognostic factors in the surgery. Methods Retrospective analysis was done upon 58 epilepsy children with MRI-positive who were operated and followed up for at least 1 year from Jun.2005 to Sep.2009.The epileptogenic zone and the surgery programs were determined according to the results of presurgical evaluations,which included video-electroencephalogram（VEEG）,MRI,positron emission tomography and computed tomography（PET-CT）,and invasive EEG（IEEG）.Surgical resections were aimed at total removal of the epileptogenic zone and the lesions.Patients were categorized as seizure free group（Engel class Ⅰ） or seizure attack group（Engel classes Ⅱ-Ⅳ）.Statistical analysis was used for the predictable prognostic factors of the surgery which included age at surgery,epilepsy duration,age at epilepsy onset,seizure types,seizure frequency,epileptogenic zone and VEEG/MRI concordance. Results According to the Engel classification,39 cases（67.2%） of the children were seizure free,including 17 cases（73.9%）of temporal lobe atrophy or hippocampal sclerosis,11 cases（91.7%）of low grade tumors,4 cases（66.7%） of arachnoid cyst,3 cases（42.9%）of cortical dysplasia,2 cases（100%） of cavernous hemangioma and 2 cases（25.0%）of malacia.Among 19 cases with seizure attacks after surgery,4 cases（6.9%）were in Engel classⅡ,7 cases（12.1%）were in Engel class Ⅲ,and 8 cases（13.8%） were in Engel class Ⅳ.The shorter epilepsy duration,low seizure frequency,not secondary genera-lized seizures and VEEG/MRI concordance were the strongest prognostic factors for favorable surgery outcome.Age at surgery,age at epilepsy onset,epileptogenic zone had no significant correlation with the surgery outcome. Conclusions Surgery is effective and should be done early for childhood epilepsy with MRI-positive.The surgery outcome can be predicted according to clinical factors and various diagnostic outcomes during the surgical treatment.