致癇性局灶性皮层发育不良的外科治疗

Surgical Treatment of Epileptogenic Focal Cortical Dysplasia

目的研究致癇性局灶性皮层发育不良(focal cortical dysplasia,FCD)的临床特点及外科手术治疗的疗效。方法对2004-01/2011-10月两所医院癫癇病灶切除术后病理证实为局灶性脑皮层发育不良患者的临床资料进行回顾性分析,总结其中各类临床资料完整的67例患者的病灶位置、病理亚型、磁共振成像(magnetic resonance imaging,MRI)特点、预后等指标,分析其相互关系。结果本组颅脑MRI阳性表现者45例,主要表现为灰白质交界不清、局部皮层增厚和形态异常、T2 WI与液体衰减反转恢复(fluid-attenuated inversion-recovery,FLAIR)像上白质信号增高等特点。其中T2、FLAIR高信号在FCDⅡb型中非常常见,而FCD I型中则少见。按照Engel预后分级法,本组Ⅰ级73.1%(49/67),Ⅱ级18.0%(12/67),Ⅲ级6.0%(4/67),Ⅳ级3.0%(2/67)。结论致癇性FCD病例MRI主要表现为灰白质交界不清、局部皮层增厚和形态异常、T2 WI与FLAIR像上白质信号增高等特点,手术治疗可达到较好疗效。

Objective To investigate the clinical characteristics ot patients with epileptogenic focal cortical dysplasi- a,and evaluate the outcomes of epilepsy surgery. Methods A retrospective analysis of the clinical data of patients with epileptogenic focal cortical dysplasia, accepted resection of the epileptic focus and confirmed pathologically in our hospital, was performed. The distribution of the lesions, histologic subtypes,magnetic resonance imaging （MRI） characteristics and prognosis of 67 patients with complete records were analyzed. Results Positive MRI manifestations were observed in 45 patients, mainly manifested as unclear junction between gray and white matter, local cortical thickening and abnormal mor- phology, and increased white matter signal on T2WI and fluid-attenuated inversion-recovery （FLAIR） imaging. High sig- nal on T2WI, FLAIR imaging was very common in patients with FCDIIb subtype and rare in patients with FCDIb subtype. According to Engel prognosis grading,73.1% （49/67） was in grade I , 18.0% （12/67） in grade H ,6. 0K （4/67） in grade I]I, and 3. 0% （2/67） in grade IV. Conclusion MRI manifestations of patients with epileptogenic focal cortical dys- plasia include unclear junction between gray and white matter,local cortical thickening and abnormal morphology, and in- creased white matter signal on T2WI, FLAIR imaging. Surgical treatment has good therapeutic effect.