难治性癫痫二次手术41例患者脑切除标本临床病理学分析

Pathologic features of the brain tissue in reoperation refractory epilepsy: a clinicopathologic study of 41 cases

目的 分析并比较接受第二次癫痫外科手术的难治性癫痫患者脑切除标本的临床病理学特点。方法 回顾性分析2008~2013年在北京市海淀医院功能神经科接受第二次手术治疗的41例难治性癫痫患者的临床资料及病理资料,并复习相关文献。结果 41例患者中男性28例,女性13例,发病年龄1~51岁（平均10.29岁）,病程2~30年（平均11.91年）,第二次手术距第一次手术0.5~20年（平均7.05年）。脑切除标本病理诊断为FCDⅢa者8例（19.51%）,FCDⅢb者11例（26.83%）,FCDⅢd者15例（36.59%）,双重病理7例占17.07%（5例为FCDⅢa伴胶质瘢痕/瘢痕脑回,1例为FCDⅢa伴血管瘤,1例为FCDⅢa伴混合性少突星形细胞瘤）。术后随访0.5~5年,EngelⅠ级25例（61.0%）,EngelⅡ级14例（34.1%）,EngelⅢ级1例（2.45%）,失访1例（2.45%）。颞叶癫痫20例（占48.78%）。结论 接受第二次癫痫外科手术的难治性癫痫患者脑切除标本病理类型仅包括FCDⅢ型和双重病理。这两种类型的患者再次手术后,效果良好,EngelⅠ级和EngelⅡ级共占95.1%。获得性脑损伤（如高热惊厥、外伤、难产等和脑肿瘤切除术后）致胶质瘢痕的形成和脑功能重建的过程、颞叶及内侧结构未能完全切除、肿瘤复发及致痫灶切除范围不够,是再次行癫痫外科手术的主要原因;精准完整的术前评估可以有效地减少再次手术的风险。

Purpose To investigate the clinieopathologie features of the brain tissues from reoperation for refractory epilepsy. Methods The clinical and pathologic findings were reviewed in 41 patients who underwent epilepsy reoperation in the Epilepsy Center of Haidi- an Hospital from 2008 to 2013. Results All patients including 28 males and 13 females had medically intractable seizures after the first epilepsy operation. The ages of seizure onset were 1 to 51 years （average age was 10.29 ）. The disease durations were 2 to 30 years （average number was 11.91 ）. The interval between first operation and the second were 0.5 to 20 years （average number was 7.05 ）. The pathological diagnoses of brain tissues were FCD Ⅲ a in 8 eases （ 19.51% ） , FCD Ⅲ b in 11 eases （ 26. 83 % ） , FCD Ⅲ d in 15 cases （36. 59% ） , and dual pathology in 7 eases （ 17.07% ）. Seizure outcome after the second operation revealed 25 patients （61.0%） had an Engel grade Ⅰ , 14 patients （34. 1% ） had an Engel grade Ⅱ , 1 patient （2. 45% ） had an Engel grade m, and 1 patient （2. 45% ） was lost follow-up. 20 cases （48.78%）belonged to intractable temporal lobe epilepsy. Conclusions The pathological diagnoses of epilepsy reoperation tissues are FCD Ⅲ and dual pathology. Most of the patients （95.1% ） wth epilepsy reoperation have good prognosis. The main causes of reoperation are ulegyria from damage, effects of first operation, not resected temporal lobe and hippoeampus, tumor relapse and residual epileptogenic brain tissue. Accurate evaluation before epilepsy operation is very important.