颞叶局灶性皮质发育不良合并海马硬化致癫痫手术预后的影响因素

Focal cortical dysplasia in temporal lobe with hippocampal sclerosis caused epilepsy： influencing factors of operative prognosis

目的探讨颞叶局灶性皮质发育不良（FCD）合并影像学表现不典型的海马硬化（HS）致癫痫患者手术预后的相关影响因素。方法回顾性分析首都医科大学宣武医院功能神经外科术后病理学证实为FCD合并HS致癫痫患者的临床资料，共24例。患者术前MRI均无典型的HS表现。根据随访结果，EngelⅠ级为治疗成功组，Ⅱ-Ⅳ级为非治疗成功组。分析影响预后的可能因素。结果术后随访24—70个月，平均42个月。17例FCDⅠ型患者中，治疗成功组有15例（15／17），非治疗成功组2例（2／17）；7例FCDU型患者中，治疗成功组有1例（1／7），非治疗成功组6例（6／7），差异有统计学意义（P=0．001）。ⅠA与ⅠB型、ⅡA与ⅡB型患者预后差异无统计学意义。治疗成功组和非治疗成功组中，合并高热惊厥史的比例分别为4／16、7／8，全切除发作区的比例分别为16／16、4／8，差异均有统计学意义（P=0．008，P=0．007）。两组间在性别、手术年龄、发作起始年龄、发作病程、术前发作频率、是否继发全面性强直阵挛发作、手术侧别、MRI是否显示颞叶病灶方面差异均无统计学意义（P〉0．05）。结论FCD合并影像学表现不典型的HS致癫痫患者的手术预后与组织病理学亚型、是否有高热惊厥史、是否全切除发作区有关。

Obsjective To investigate the related factors of operative prognosis influencing the focal cortical dysplasiain （FCD） with imaging atypical hippocampal sclerosis （HS） caused epilepsy in patients with operative prognosis. Methods The clinical data of 24 FCD patients with HS caused epilepsy confirmed by pathology after functional neurosurgical procedure at the Department of Functional Neurosurgery, Beijing Institute of Functional Neurosurgery from August 2006 to December 2009 were analyzed retrospectively. The patients did not have any manifestations of typical HS on MRI before procedure. According to the follow-up results, Engel grade Ⅰ was a successful treatment group and grade Ⅱ - Ⅳ was a non-successful treatment group. The possible factors affecting the prognosis were analyzed. Results The postoperative follow-up ranged from 24 to 70 months （ mean, 42 months ）. Among the 17 patients with FCD type Ⅰ, 15 （15/17） were in the successful treatment group and 2 （2/17） were in the non- successful treatment group; among 7 patients with FCD type Ⅱ , 1 （1/7） was in the successful treatment group and 6 （6/7） were in the non-successful treatment group. There was significant difference （ P = 0. 001 ）. There were no significant differences in the prognoses of the patients between type Ⅰ A and type Ⅰ B or type Ⅱ A and type Ⅱ B. The proportions of the combined history of febrile seizure in the successful treatment group and the non-successful treatment group were 4/16 and 7/8 respectively, and the proportions of complete removal of the seizure onset zone were 16/16 and 4/8 respectively. There was significant difference （P = 0. 008, P = 0. 007 ）. There were no significant differences in gender, age at operation, onset age, course of onset, preoperative seizure frequency, having secondary generalized tonicclonic seizures or not, operative sides, and revealing foci or not on MRI between two groups （P 〉 0.05 ）. Conclusions The operative prognoses of the patients with FCD and imaging atypical HS caused epilepsy are associated with histopathological subtypes, having a history of febrile seizure or not, total resection of seizure onset zone.