幕上肿瘤周围皮层脑电特征、病理改变与癫痫的临床研究

Clinical study of electroencephalogram features,pathological changes and epilepsy on the cortex around supratentorial tumors

目的:探讨幕上肿瘤继发癫痫患者皮层脑电异常放电脑组织脑电表现特征及病理学改变。方法:选择36例伴癫痫发作的非功能区幕上肿瘤患者,在术中皮层脑电(electrocorticography,ECoG)监护下行肿瘤切除+痫样放电组织切除术。将切除有癫痫样放电的脑皮质作为试验组,无痫样放电的显微镜下显示肿瘤周边正常的哑区组织或内减压脑组织作为对照组。分析试验组ECoG波型特点,比较试验组与对照组术后病理检查的结果。结果:(1)幕上肿瘤继发癫痫患者ECoG波型特点以间隙性多棘波最多,有14例(38.89%);其次分别为持续出现单个棘波;广泛棘尖波节律。(2)病理特点:36例试验组痫样放电皮层脑组织病理改变以不可逆改变胶质瘤细胞和单纯胶质细胞增生为主,共21例(58.33%)。30例对照组中仅7例(23.33%)出现胶质细胞增生。试验组胶质瘤或胶质增生明显高于对照组(P<0.05)。(3)试验组ECoG波型特点与病理结果比较:持续性单个棘波,主要见于不可逆改变组,差异有统计学意义(P<0.05);间隙性多棘波、广泛性高幅夹波节律可见于2组中,2组比较差异无统计学意义(P>0.05)。结论:幕上肿瘤继发癫痫患者ECoG波型表现以持续出现单个棘波为主;异常放电脑组织的病理学改变多为胶质瘤细胞和胶质细胞增生;肿瘤周围ECoG反复出现极高幅持续性棘波脑皮质区应积极处理。

Objective：To explore the electroencephalogram（EEG） features and pathological changes of brain tissue with EEG abnor- malities in patients with supratentorial tumors complicated with secondary epilepsy. Methods：Totally 36 patients with nonfunctional area supratentorial tumors complicated with secondary epilepsy were enrolled. Tumor and epileptiform discharges resection under the eleetrocorticography（ECoG） monitoring were performed. The resected brain cortex with epileptic discharges was as defined as experi- mental group and normal dumb organization（parenthesis of tumor resection） without epileptic discharges under the microscope in the tumor surrounding or decompression brain tissue was defined as control group. Characteristics of ECoG wave in experimental group were analyzed and postoperative pathologic results in experimental group and control group were compared. Results：（ 1 ）Characteristics of ECoG wave in patients with supratentorial tumors： 14 cases（38.89%） showed intermittent polyspikes,followed by continuous spike and generalized sharp wave rhythm. （2）Pathological features：21 cases（58.33%） in experimental group showed irreversible glioma cell and simple glial cell hyperplasia and only 7 out of 30 cases（23.33%） in control group found glial cell hyperplasia. Glioma or glial cell hyperplasia was significantly higher in experimental group than in control group （P〈0.05）. （3）Pathological results and characteristics of ECoG wave in experimental group：in nonreversible group：continuous single spike was mainly seen（P〈0.05）. Intermittent polyspikes and generalized high amplitude sharp wave rhythm can seen both in two groups（P〉0.05）. Conclusions：ECoG wave manifests mostly as continuous single spike in patients with supratentorial tumors complicated with secondary epilepsy. Pathological features of brain tissues with ECoG abnormalities are glioma cells and glial cell hyperplasia. Cerebral cortex around the tumor with recurring single high amplitude spikes, clusters multi-spikes and spike-sharp-wave rhythm of discharge in ECoG should be actively treated.