40例颅脑MRI阴性的难治性癫痫患者手术疗效研究

Seizure Outcome after Surgery in 40 Patients with Normal Preoperative MRI and Intractable Epilepsy

目的本文探讨手术治疗颅脑MRI阴性的难治性癫痫患者术后疗效。方法收集2008年1月至2009年12月我院神经外科收治的73例手术治疗的难治性癫痫患者临床资料,回顾性分析其病历资料及手术疗效。依据影像学结果分组:第一组患者颅脑MRI阴性,第二组颅脑MRI发现异常。所有患者明确致痫灶后行手术治疗,术中使用皮层电极再次定位致痫灶。对于术前无法明确致痫灶者,行皮层电极埋藏定位;术后标本常规行病检。术后至少进行1年以上的随访,按Engel分级评价术后疗效。结果第一组术后平均随访1.8年,16例(40%)达到EngelⅠ级;19例(47.5%)达到EngelⅡ级;3例(7.5%)为EngelⅢ级;2例(5%)患者为EngelⅣ级。第二组术后平均随访1.8年,18例(54.5%)术后达到EngelⅠ级;7例(21%)达到EngelⅡ级;4例(12%)为EngelⅢ级;4例(12%)为EngelⅣ级。两组术后癫痫控制疗效差异无统计学意义(P<0.05)。结论本研究显示颅脑MRI阴性癫痫患者经过严格的术前评估及筛选具有早期手术治疗的价值。

Objective To discuss the seizure outcome of the patients with normal MRI after surgical treatment. Methods A retrospective study during January 2008 to December 2009 in Neurosurgery department of the 363 hospital. 73 patients admit-ted to surgical treatment with refractory epilepsy. And we collect their medical records. In accordance with the brain MRI scan,we divide the surgical patients into two groups：the first group of all patients with negative MRI results, the second group of all pa-tients had abnormal brain MRI results. All the patients were underwent surgical treatment before rigorous assessments. During the operation,we used cortical electrode monitoring to determine resection area. If the epileptic foci couldn＆#39;t be identified, The cortical electrodes were needed to be buried on the surface of the brain. All specimens were resected for pathological examination. All pa-tients were followed up at least a year. And the efficacy of seizure control was evaluated according to Engel classification. Re-sultsThe first group were followed up for 1. 8 years. 16 patients （40%） had Engel classification 1. 19（47. 5%） had Engel classifi-cation 2. 3（7. 5%）had Engel classification 3. 2（5%）Engel classification 4. The second groups were followed up for 1. 8 years. 18 patients（54. 5%） had Engel classification 1. 7（21%） patients had Engel classification 2. 4（12%）patients had Engel classifica-tion 3. 4 patients（12%） had Engel classification 4. Efficacy of postoperative seizure control had no statistically significant differ-ence between two groups. Conclusion This study showed that patients with MRI negative epilepsy, with strict preoperative evalu-ation and screeuing, have early surgical value.