皮质脑电图在颅内胶质瘤继发癫痫患者手术中的应用

Application of electrocorticography in patients with epilepsy secondary to intracranial glioma during surgery

目的探讨颅内胶质瘤继发癫痫患者于皮质脑电图(ECoG)监测下行胶质瘤切除手术的有效性和安全性。方法选取45例颅内胶质瘤伴癫痫发作患者,所有患者均于ECoG监测下显微手术切除肿瘤及处理致痫灶。结果45例患者均顺利地接受了显微镜肿瘤切除术治疗,无死亡病例,肿瘤全切除率为86.67%(39/45),平均手术时间为(178.23±35.63)min,术后平均住院时间为(10.25±3.28)天。术后病理检测结果显示,Ⅰ级19例,Ⅱ级14例,Ⅲ级8例,Ⅳ级4例。星形胶质细胞瘤34例,少突胶质细胞瘤9例,胚胎发育不良性神经上皮瘤2例。Ⅲ、Ⅳ级患者接受了放疗和化疗的辅助治疗。术后7例患者出现一过性肌力下降,2例患者出现一过性失语,经对症治疗后恢复术前水平。术后随访1~5年,死亡9例,复发9例;术后癫痫发作控制达Ⅰ级者31例,达Ⅱ级者11例,达Ⅲ级者3例;癫痫发作控制的总有效率达93.33%(42/45)。结论ECoG监测下显微手术切除肿瘤及处理致痫灶在切除病变的同时最大限度地保护了脑功能,有助于术后癫痫的控制。

Objective To assess the efficacy and safety of glioma resection surgery using intraoperative electrocorticography(ECoG)monitoring in patients with epilepsy secondary to intracranial glioma.Method The clinical data of 45 patients with intracranial glioma combined with epilepsy were retrospectively analyzed,all patients underwent microscopic surgery to remove tumors and identify epileptogenic focus under ECoG monitoring.Result All the 45 patients were successfully treated with microscopic glioma resection,there were no deaths,with a radical resection rate of 86.67%(39/45)for gliomas.The average operative time was(178.23±35.63)min,and the postoperative hospital stay was(10.25±3.28)d.Postoperative pathological examination revealed 19 cases of gradeⅠ,14 cases of gradeⅡ,8 cases of gradeⅢ,and 4 cases of gradeⅣin terms of glioma classification.There were 34 cases of astrocytoma,9 cases of oligodendroglioma,and 2 cases of dysembryoplastic neuroepithelial tumor.Patients with grade Ⅲ andⅣtumors received adjuvant treatment with radiotherapy and chemotherapy.Seven patients developed a transient decline of muscle strength decline after operation,and two patients had transient aphasia,and all were resolved and returned to preoperative level after symptomatic treatment.After 1 to 5 years of follow-up,9 deaths and 9 relapses were reported;in terms of epilepsy control,31 cases achieved gradeⅠ,11 cases attained gradeⅡ,and 3 cases were at gradeⅢ,resulting in an overall response rate of epilepsy control of 93.33%(42/45).Conclusion Under ECoG monitoring,microsurgical removal of glioma and treatment of epileptogenic focus minimize the lesions to the greatest extent while protecting the brain function,is helpful for postoperative epilepsy control.