影响癫痫起始区和脑结构异常区关系的病理学因素探讨

A pilot study of pathological factor affecting the anatomical relationship between epilepsy onset zone and abnormal cerebral area

目的探讨癫痫起始区（EOZ）和脑结构异常区（ACA）的解剖关系及影响二者关系的病理学因素。方法回顾性分析2007年11月至2009年11月在北京市海淀医院功能神经科手术治疗的358例癫痫患者的临床资料，22例符合本研究标准。即头磁共振（MRI）证实脑内有异常结构改变，经头皮脑电图（SEEG）和颅内电极脑电图（iEEG）确定癫痫起始区后，测量两者间距离，定义其解剖关系为重叠（〈5mm）、相邻（5—20mm）、远离（〉20mm）。对结构异常区进行病理学研究。结果EOZ与ACA重叠者4例、相邻者13例、远离者5例。脑异常结构的病理结果为：皮质发育不良6例，海绵状血管瘤4例，神经节细胞瘤和灰质异位各3例，脑动静脉畸形、脑软化灶和胚胎发育不良性神经上皮肿瘤各2例。血管性病变、颅内肿瘤等患者的EOZ多位于ACA周围，皮质发育不良、灰质异位、脑软化坏死等患者的EOZ多远离ACA。结论EOZ与ACA的关系与ACA病理性质有较密切关系，对临床手术及预后有一定指导意义。

Objective To explore the pathological factors that affect the anatomical correlation between epilepsy onset zone （EOZ） and abnormal cerebral area （ACA） . Methods Three -hundred and fifty- eight eases were retrospectively analyzed in department of functional neurology and neurosurgery of Beijing Haidian Hospital between November 2007 and November 2009, 22 cases of who with epilepsy due to cerebral lesion had underwent EOZ and/or ACA resection after comprehensive evaluations of MRI, Scalp - EEG and intraeranial -EEG monitoring. The anatomical correlation between EOZ and ACA was defined as overlapping （ 〈5 mm）, adjacency （5 ~20 mm） and separation （ 〉20 ram） according to their distance. Pathological study was performed to analyze the pathology of ACA. Results The results of the distance between EOZ and ACA were 4 cases of overlapping （ 〈 5 mm） , 13 of adjacency （5 ~ 20 mm ） and 5 of separation （ 〉 20 mm）. The pathological results included 6 cases of malformation of cortical development （MCD）, 4 cases of cavernous hemangioma, 3 cases of gangliocytoma and heterotopic gray matter （HGM） respectively, 2 cases of arteriovenous malformation （AVM） and dysembryoplastic neuroepithelial tumor （DNT） and eneephalomalacia respectively. Most of the cases of overlap and adjacency were vascular lesions and tumors verified by pathological examinations, the others were MCD and encephalomalacia. Conclusion The pathological nature of the ACA had an important role in determining the correlation between EOZ and ACA, which may guide the surgical options and influence the patient＇s prognosis.