儿童后象限脑皮质发育障碍致难治性癫癎的手术治疗

Surgery for pediatric intractable epilepsy due to posterior quadrantic cortical dysplasia

目的探讨儿童后象限脑皮质发育障碍致难治性癫癎的临床特点、手术策略及疗效。方法分析14例后象限皮质发育不良(PQD)致难治性癫癎患儿的症状学特征及术前评估结果,总结视频脑电图检查、术中监测的定位价值及颞顶枕叶离断术的适应症和优缺点。结果 14例PQD患儿的癫癎发作有多种发作形式,但以痉挛发作最常见。2例皮质发育不良涉及中央区。14例患儿行颞顶枕叶离断手术,术后13例无发作,1例发作减少>50%。结论颞顶枕叶离断术是儿童后象限皮质发育障碍所致难治性癫癎外科手术治疗较安全的一种术式,并获得了满意的癫癎控制效果。

Objective To investigate the clinical features and surgical strategy for pediatric intractable epilepsy due to posterior quadrantic cortical dysplasia and to assess the surgical outcomes. Methods The clinical features and preoperative evaluation results of 14 children with intractable epilepsy due to posterior quadrantic cortical dysplasia were retrospectively analyzed. The localization values of video-electroencephalography and intraoperative monitoring and the indications, advantages and disadvantages of temporoparietooccipital disconnection were evaluated. Results The 14 children had different seizure types, of which spasm was the most common one. The lesions of cortical dysplasia involved the central cerebral region in 2 cases. After temporoparietooccipital disconnection in 14 patients, 13 cases were seizure-free; only one case still had seizures, but the frequency dropped by more than 50%. Conclusions Temporoparietooccipital disconnection is a safe and effective surgical procedure for children with intractable epilepsy due to posterior quadrantic cortical dysplasia.