儿童颞叶癫痫的临床特点及手术疗效分析

Clinical characteristics and surgical treatment of temporal lobe epilepsy in children

目的探讨儿童难治性颞叶癫痫的特点及手术治疗效果。方法回顾性分析本院神经外科收治并进行手术治疗的25例儿童颞叶癫痫病例资料,对其年龄、侧别、脑电图特点、手术方式、病理结果及手术疗效进行分析。结果本院自2012年6月至2016年9月共收治儿童颞叶癫痫患儿25例,男14例,女11例,平均年龄(6.55±2.98)岁(2~12岁),左侧11例,右侧14例;术前平均口服2种抗癫痫药物(1~3种),脑电图部分性发作24例;全面性发作1例,表现为Lennox-Gastaut综合征;25例中,行颞前叶及海马杏仁核切除术6例,颞叶新皮层切除术4例,病灶切除术12例,立体定向脑电图植入(SEEG)术后再行切除3例;术后病理检查结果提示低级别肿瘤8例,局灶性皮层发育不良5例,海绵状血管瘤2例,低级别肿瘤伴神经元变性及胶质增生(FCDⅢb)8例,海马硬化伴皮层发育不良(FCDⅢa)2例。无手术死亡病例,术后无出血、感染、脑积水等并发症。术后随访无新发语言及记忆损害,根据谭启富教授术后分级标准,21例术后疗效Ⅰ级(21/25),3例(3/12)术后疗效Ⅱ级,1例(1/12)术后疗效Ⅲ级。不同手术方式对术后疗效无显著影响(P>0.05),但在皮层脑电监测下指导切除可获得更优的癫痫控制效果(P=0.034)。结论儿童颞叶癫痫不同于成人颞叶癫痫,主要以低级别肿瘤和局灶性皮层发育不良为主,而非海马硬化。按照癫痫外科治疗原则,利用术中皮层脑电监测指导手术切除,可以取得更好的癫痫控制效果。

Objective To explore the clinical characteristics and surgical treatment of intractable tempo-ral lobe epilepsy in children.Methods A retrospective review was performed for consecutive patients undergoing resection for temporal lobe epilepsy between June 2012 and September 2016. Such clinical characteristics as age, laterality, pathological findings, surgical approaches and seizure outcomes were analyzed. Results Twentyfive patients （ 14 boys, 11 girls） with a mean age （± standard deviation） of 6.55 ± 2.98 years （ range .2 - 12 years） were included. The involved side was left （ n = 11 ） and right （ n = 14）. Among 24 patients with partial seizures, 1 case of generalized seizures was Lennox-Gastaut syndrome on scalp EEG. Resections included anteri- or temporal lobe and hippocampus amygdala （u = 6） ,temporal neocortex （m =4） ,lesion （n = 12） and surgery after stereotactic implantation of depth electrode （ u = 3 ）. The major pathological findings included low-grade glioma （ n = 8 ） ,focal cortical dysplasia （ n = 5 ）, cavernous malformations （ n = 2） ,low-grade glioma with cortical dysplasia （ FCD Ⅲ b） （ u = 8） and hippocampal sclerosis with cortical dysplasia （ FCD Ⅲ a） （ n = 2）. There was no occurrence of such postoperative complications as bleeding, infection or hydrocephalus. No language or memory impairment was observed after operation. Twenty-one patients remained seizure-free （21/25） , seizure frequency decreased 〉 75% （ n = 3,3/12） and 〈75% （ n = 1,1/12）. Different surgical approaches had no significant effect on postoperative curative efficacy （P 〉 0.05 ）. Better seizure control outcomes could be obtained under the guidance of electrocorticography （EcoG） monitoring （P =0. 034）. Conclusion Temporal lobe epilepsy in childhood is different from its adult counterpart. The most common abnormalities are low-grade tmnors and focal cortical dysplasia,but not hippocampus sclerosis, intraoperative EcoG is a useful adjunct for ensuring a complete removal of epileptogenic zone and achieving optimal seizure freedom.