幕上脑膜瘤继发癫痫的危险因素分析及手术治疗效果

Risk factors and surgical outcome of secondary epilepsy arising from supratentorial meningioma

目的探讨幕上脑膜瘤继发癫痫的危险因素以及手术对继发癫痫的疗效。方法回顾性分析2015年1月至12月首都医科大学附属北京天坛医院神经外科收治的267例脑膜瘤患者的临床资料。所有患者均行手术切除肿瘤,术后对癫痫预后进行电话或门诊随访。应用单因素分析和多因素Cox比例风险模型分析探讨影响幕上脑膜瘤继发癫痫发作的因素。结果本组患者脑膜瘤继发癫痫的发生率为17.2%(46/267)。单因素分析结果提示,脑膜瘤位于围中央区皮质(P<0.01)、男性(P=0.01)、青年患者(<45岁,P<0.01)以及伴有脑积水(P<0.01)与脑膜瘤术前继发癫痫有关。多因素Cox比例风险模型分析结果显示,脑膜瘤位于围中央区皮质(HR=2.21,95% CI:1.23~3.97,P=0.008)以及青年患者(<45岁)(HR=2.03,95%CI:1.11~3.68,P=0.021)是幕上脑膜瘤继发癫痫的独立危险因素。213例患者获随访,平均随访(24±13)个月。术前伴发癫痫的患者行脑膜瘤切除术后的癫痫无发作率为80.4%(37/46)。结论癫痫是脑膜瘤较常见的临床表现,肿瘤位于运动相关皮质以及青年患者更易伴发癫痫发作。幕上脑膜瘤继发癫痫患者单纯行肿瘤切除可获得较好的癫痫预后。

Objective To elucidate the risk factors and surgical outcome of secondary epilepsy arising from intracranial meningioma.Methods A retrospective study was conducted on the clinical data of 267 patients with intracranial meningioma admitted to Department of Neurosurgery,Beijing Tiantan Hospital,Capital Medical University from January 2015 to December 2015.All those patients underwent surgical operations.The seizure outcome was followed up through outpatient visits or telephone post operation.Univariate analysis and Cox proportional hazards model were applied to identify the predictive factors for epileptic seizures in patients with supratentorial meningioma.Results In this series,the incidence of epileptic seizures arising from meningioma was 17.2%(46/267).Univariate analysis demonstrated 4 predictive factors for preoperative epilepsy:tumor location (perirolandic area)(P <0.01),male patients (P = 0.01),young people (less than 45 years old)(P <0.01)and hydrocephalus (P <0.01).Two independent predictors were confirmed by multivariate analysis:tumor location (perirolandic area)(HR =2.21,95% CI: 1.23-3.97,P =0.008)and young people (HR=2.03,95% CI.1.11-3.68,P=0.021).A total of 213patients were successfully followed up for an average duration of 24±13 months.Also,the status seizure free was reported in 80.4%(37/46)of the meningioma patients with preoperative seizures.Conclusions Epileptic seizures are common in patients with meningiomas and more likely to be observed in those with tumors located in motorrelated areas and young people.Tumor resection could result in favorable seizure outcome.