低级别胶质瘤伴局灶性脑皮质发育不良的癫痫患者手术治疗

Surgical treatment of low-grade glioma with focal cortical dysplasia in patients with epilepsy

目的应用多模态术前评估体系指导低级别胶质瘤伴局灶性皮质发育不良癫痫患者的手术。方法回顾性分析2018年2月-2018年10月于兰州大学第二医院行手术治疗并经术后病理证实为胶质瘤伴局灶性皮质发育不良的5例癫痫患者临床资料。围手术期评估均采用多模态评估体系,即采用多学科讨论、多种影像结合、多种方法评估的手段,以期提高致痫灶全切除率,达到发作完全缓解的目的。术后随访5个月以上,根据Engel分级评估方法将EngelⅠ级定义为预后良好,EngelⅡ-Ⅳ级定义为预后不佳。结果 5例患者术后病理检查显示4例为节细胞胶质瘤,1例为弥漫性星形细胞瘤,均伴有局灶性皮质发育不良改变。其中2例术后术区少量出血,经治疗均已痊愈。病灶定位左侧枕叶皮质1例,额叶上回1例,颞叶及海马2例,岛叶1例。5例癫痫灶切除术后随访5~16个月,癫痫无发作,均为Engel Ⅰ级。结论多模态评估体系可以提高低级别颅内肿瘤伴局灶性皮质发育不良癫痫患者预后。在制定肿瘤继发癫痫患者手术策略时不应只关注肿瘤本身,肿瘤周围可能伴有皮质发育不良病灶,这可能是致痫的根本原因。

Objective To apply a multimodal preoperative evaluation system to guide the operation of patients with low-grade glioma with focal cortical dysplasia epilepsy.Methods The clinical data of 5 patients with glioma complicated with focal cortical dysplasia who underwent surgical treatment at the Second Hospital of Lanzhou University were collected.The perioperative evaluation was performed using a multimodal evaluation system-multidisciplinary discussion,multi-image combination and multi-method evaluation,so as to improve the total resection rate of epileptic foci and achieve the goal of complete remission.After a follow-up of more than 5 months,the Engel Ⅰ was defined as a good prognosis and Engel Ⅱ-Ⅳ was defined as a poor prognosis according to the Engel assessment method.Results The postoperative examination of 5 patients showed 4 cases of ganglion cell glioma and 1 case of diffuse astrocytoma,the 5 cases were all found with focal cortical dysplasia.Two of the patients had a small amount of bleeding in the operation area and disappeared at the time of discharge.One lesion was located in the left occipital cortex,one in the upper frontal lobe,two in the temporal lobe and hippocampus,and one in the insula.Five cases of epileptic foci were followed up for 5~16 months without seizures,all graded as Engel Ⅰ.Conclusions Multimodal assessment system can improve the prognosis of patients with low-grade intracranial tumors with focal cortical dysplasia.In the development of surgical strategies for patients with epilepsy secondary to intracranial tumors,attention should not be paid only to the tumor itself,dysplasia may be associated with tumors,often the underlying cause of epilepsy.