功能区肿瘤继发癫痫的手术治疗

Surgical treatment of epilepsy with tumors in the eloquent areas

目的总结我科近年来治疗功能区肿瘤继发癫痫的治疗经验，探讨功能区肿瘤继发癫痫的外科治疗原则和方法。方法对2011年5月-2013年5月在我院接受手术治疗的50例功能区肿瘤继发癫痫的患者进行回顾性分析。结果全组病例术前均行系统癫痫外科评估。其中12例行颅内电极皮层电刺激功能区定位，根据肿瘤大小和脑电图所监测到的致痫区以及皮层电刺激所确定的功能范围制定手术切除范围，术后1例出现对侧手指轻瘫，1例出现一过性对侧肢体偏瘫，1例出现一过性失语，其余术后随访无明显神经功能障碍。未行颅内埋藏电极患者38例，综合运用MRI、术中皮层脑电监测和术中B超等多种方法来确认手术切除范围，术后神经功能缺损术后加重5例，7例术后出现对侧肢体轻瘫，2例出现对侧偏麻，4例出现一过性失语。全组术后癫痫无发作达到EngelⅠ级42例（84％）。结论功能区肿瘤继发癫痫的外科治疗要兼顾肿瘤的全切、致痫灶的切除以及功能区的保护。术者的经验和熟练的显微操作是基本前提，术前综合运用多种评估方法，结合术中皮层脑电及术中B超等方法对病灶，致痫区以及功能区进行定位，对保证手术效果起重要作用。颅内埋藏电极长程脑电监测定位致痫灶，并经皮层电刺激定位功能区，可进一步明确病变与致痫灶、功能区重叠程度及毗邻关系，从而为手术切除范围的界定提供了关键信息。

Objective To explore the strategy for the surgical treatment of epilepsy pa- tients with lesions in the eloquentl areas. Methods Fifty patients with epilepsy and tumors in the eloquent areas including the pre--and post--central gyri who underwent resection of lesion were included. Among them, subdural electrodes were implanted in 12 patients, followed by long--term video EEG monitoring and functional brain mapping by cortical electrical stimulation. All patients were followed up for 3 - 24 months. Results Implantation of intracranial electrodes was per- formed in 12 patients. Intracranial EEG recorded interictal abnormalities in 10 patients （83%） and ictal discharges in 8 patients. Functional mapping showed total overlapping of the lesion and the functional region in 4 patients, subtotal overlapping in 2 patients, and the lesion being close to the functional region in 6 patients. During follow--up,42 patients were in Engel Ⅰ （84%）, 7 in Engel Ⅱ （14%） ,and one in Engel Ⅲ （2%）, respectively. Conclusion Complete removal of lesions and epileptogenic zones and protection of functions are of great importance in the surgical treatment of epilepsy patients with tumors in the eloquent areas. Intracranial EEG recording and functional brain mapping by electrical cortical stimulation help to exact localization of epileptogenic focus and identification of the relation and overlapping of the lesion, epileptogenic focus and the func-tional region.