癫痫灶切除手术治疗儿童和青少年难治性癫痫的回顾性分析

Resection of epileptic foci for children and adolescents with refractory epilepsy： a retrospective analysis

目的 探讨切除性手术治疗儿童和青少年难治性癫痫患者的临床特点和疗效.方法 纳入首都医科大学宣武医院功能神经外科2001年4月至2014年12月行切除性手术治疗的≤18岁的难治性癫痫患者,共620例.回顾性分析儿童及青少年癫痫外科治疗的临床特点和手术疗效.结果 620例中,低龄组（0～7岁）132例,学龄组（＞7～12岁）171例,青春期组（＞12～18岁）317例.MRI定位癫痫灶阴性者169例（27.3％）,阳性者451例（72.7％）.280例（45.2％）行颅内电极长程监测.颞叶癫痫（TLE） 160例（25.8％）,非颞叶癫痫（ETLE）415例（66.9％）,半球性病损引发癫痫45例（7.3％）;不同年龄组中癫痫类型差异有统计学意义（P =0.002）,其中青春期组TLE的比率最高（31.5％,100/317）,学龄组ETLE最高（73.7％,126/171）,低龄组半球性病损引发癫痫的比率最高（14.4％,19/132）.620例术后平均随访（1.6±1.1）年,409例（66.0％）发作消失,MRI阳性组和阴性组发作消失的比率分别为71.2％（321/451）、52.1％（88/169）,差异有统计学意义（P =0.000）.术后TLE组、ETLE组、半球性病损组发作消失的比率分别为75.0％（123/164）、60.1％（247/411）及86.7％（39/45）.术后14例（2.3％,14/620）发生较严重的并发症.病理学检查局灶性皮层发育不良（FCD） 213例（34.4％）,肿瘤性病变56例（9.0％）,结节性硬化31例（5.0％）,海马硬化97例（15.6％,包括39例海马硬化伴FCD）,其他病变223例（36.0％）.结论 癫痫灶切除手术是儿童和青少年难治性癫痫的一项安全有效的治疗措施,不同年龄组的临床特点存在差异.

Objective To investigate the clinical characteristics and surgical efficacy of resection of refractory epilepsy in children and adolescents.Methods From April 2001 to December 2014,a total of 620 patients with refractory epilepsy （≤ 18 years old） resected at the Department of Functional Neurosurgery,Beijing Xuanwu Hospital,Capital Medical University were enrolled.The clinical characteristics and surgical outcomes of the surgical treatment in children and adolescents were analyzed retrospectively.Results In 620 patients,there was 132 children in a younger group （0-7 years old）,171 in a school-age group （7-12 years old）,and 317 in an adolescent group （〉 12-18 years old）.The 169 patients （27.3%） with epileptic focus negative and 451 （72.7%） with epileptic focus positive were located by MRI.A total of 280 patients （45.2%） underwent intracranial electrode long-term monitoring.There were 169 patients with temporal lobe epilepsy （TLE）,415 （66.9%） with extra-temporal lobe epilepsy （ETLE）,and 45 （7.3%） with epilepsy caused by hemisphere lesions.There were significant differences in the epileptic types among the different age groups （P =0.002）.The proportion of TLE in the adolescent group was the highest （31.5%,100/317）,the ETLE in the school-age group was the highest （73.7%,126/171）,and the proportion of epilepsy caused by the hemisphere lesions was the highest （14.4%,19/132）.After procedure,620 patients were followed up for a mean of 1.6 ± 1.1 years,409 （66.0%） were seizure-free.The proportions of seizure-free in the MRI positive group and negative group were 71.2% （321/451） and 52.1% （88/169） respectively.There was significant difference （P =0.000）.The proportions of seizure-free in the TLE group,ETLE group,and hemispheric lesion group were 75.0% （123/164）,60.1% （247/411）,and 86.7% （39/45）,respectively.More serious complications occurred in 14 cases （2.3%,14/620） after procedure.Pathological examination found that 213 patients （34.4%） had focal cortical dysplasia （FCD）,56 （9.0%） had neoplastic lesions,31 （5.0%） had nodular sclerosis,and 97 （15.6%） had hippocampal sclerosis （including 39 hippocampal sclerosis with FCD）,and 223 （36.0%） had other lesions.Conclusions Epileptic focus resection is a safe and effective treatment measure for refractory epilepsy in children and adolescents.The clinical characteristics of the different age groups are different.