矢状窦、大脑镰旁脑膜瘤手术与继发性癫痫的控制及防治

Surgeries for parasagittal and parafalcine meningiomas and control and prevention/treatment of secondary epilepsy

目的分析继发性癫痫在矢状窦、大脑镰旁脑膜瘤中的发生机制及危害,探讨如何预防和减少肿瘤相关性癫痫的发生。方法回顾性分析自2011年3月~2016年6月我科住院手术的23例窦、镰旁脑膜瘤患者的临床资料,通过对比不同肿瘤特征的手术方法及继发性癫痫的发生情况。结果全部病例均手术治疗,其中肿瘤I级切除19例,II级切除4例。术前有癫痫发作7例,术后24小时癫痫发作1例,术后24小时~7天发生癫痫5例,2年内新增癫痫病例5例,3例部分运动性失语,4例出现对侧不同程度肢体偏瘫,卡方检验比较得出瘤周有无水肿(p=0.007)及术前有无使用抗癫痫药物(p=0.027)对术后继发性癫痫的发生具有影响。结论肿瘤相关性癫痫对窦、镰旁脑膜瘤患者术后危害极大,术前有癫痫病史的患者在围手术期应积极给予抗癫痫治疗,对于有明显瘤周水肿、术中脑挫伤、回流静脉损伤等高危患者术后应积极给予药物预防治疗。

Objective To investigate the pathogenesis and harm of secondary epilepsy in parasagittal and parafalcine meningiomas and effective measures for preventing and reducing tumor-related epilepsy.Methods A retrospective analysis was performed for the clinical data of 23 patients with parasagittal and parafalcine meningiomas who were hospitalized in our department from March 2011 to June 2016 and underwent surgery.The surgical methods for tumors with different features and the incidence of secondary epilepsy were compared.Results All patients underwent surgical treatment,among whom 19 underwent grade Ⅰ tumor resection and 4 underwent grade Ⅱ tumor resection.Of all patients,7 experienced seizures before surgery,1 experienced seizures within 24 hours after surgery,and 5 experienced seizures within 24 hours to 7 days after surgery;there were 5 new cases of epilepsy within 2 years.Three patients developed partial motor aphasia and 4 developed varying degrees of hemiplegia in the contralateral extremities.The chi-square test showed that the presence or absence of peritumoral edema （P =0.007） and whether anti-epileptic drugs were used before surgery （P =0.027） influenced the development of postoperative secondary epilepsy.Conclusions Tumor-related epilepsy is a great harm to patients with parasagittal and parafalcine meningiomas after surgery.Antiepileptic therapy should be given to patients with a history of preoperative epilepsy in the perioperative period,and pharmacological prevention and treatment should be provided to high-risk patients with marked peritumoral edema,intraoperative cerebral contusion,and vein injury.