以癫痫起病的儿童颞叶肿瘤及外科治疗策略

Surgical treatment for temporal lobe tumors presenting as epilepsy in children

目的探讨以癫痫起病的儿童颞叶肿瘤的病理类型、手术方案及疗效。方法对34例以癫痫起病的儿童颞叶肿瘤患者的病理、手术方法及治疗效果等临床资料进行回顾性分析。结果 34例患儿中,胚胎发育不良性神经上皮肿瘤15例,节细胞胶质瘤10例,血管中心性胶质瘤3例,星形细胞瘤3例,毛细胞星形细胞瘤2例,恶性肿瘤(非典型性胚胎样/杆状瘤)1例。肿瘤全切除32例,部分切除2例,仅在恶性肿瘤的1例患者中见肿瘤复发。术后癫痫疗效评定:Engel 1级21例,Engel 2级11例,Engel 3级2例。总有效32例,总有效率94.1%。结论以癫痫起病的儿童颞叶肿瘤以良性肿瘤多见,手术治疗预后良好;根据病理类型采用合理的手术方案,并应用术中脑电图监测,可以有效治疗癫痫。

Objective To investigate the pathological results,surgical plans and treatment outcomes of temporal lobe tumors presenting as epilepsy in children. Methods The clinical data such as pathological results,surgical procedures and treatment outcomes of 34 pediatric patients,who presented with epilepsy due to temporal lobe tumors,were retrospectively analyzed. Results The pathology of the tumor confirmed the diagnosis of dysembryoplastic neuroepithelial tumors in 15 patients,gangliogliomas in 10 patients,angiocentric glioma in 3 patients,astrocytoma in 3 patients,pilocytic astrocytoma in 2 patients,and malignant tumor in 1 patient. The tumor was totally resected in 32 patients,and partly resected in 2. Tumor recurrence was seen in only 1 patient whose pathology was malignant tumor. Post- operative Engel Assessment demonstrated Grade 1 in 21 cases,Grade 2 in 11,and Grade 3 in 2. A total of 32 cases were effectively treated,with an effective rate of 94. 1%. Conclusion Temporal lobe tumors presenting as epilepsy in children were mostly benign with good prognosis of surgical treatments. Proper choice of surgical plans based on tumor pathology and using intraoperative cortical EEG monitoring were the effective treatment for epilepsy.