节细胞胶质瘤患者手术前后癫痫发作的危险因素分析

Risk factors for pre-and postoperative seizures in patients undergoing ganglioglioma resection in a single-institution series

目的探讨节细胞胶质瘤患者手术前后癫痫发作的危险因素。方法回顾性分析1991年1月至2018年12月于东部战区总医院神经外科接受手术治疗的58例节细胞胶质瘤患者的临床资料,收集患者基本信息、临床特点、影像及病理资料等,通过电话随访和定期复查等方式了解患者出院后癫痫控制效果,以及治疗、复发及生存情况。对节细胞胶质瘤患者的资料进行单因素相关分析和多元logistic回归分析。结果58例中,术前癫痫发作30例(51.7%)。49例进行临床随访,26例术前有癫痫发作,其中EngelⅠ级19例(73.1%),EngelⅡ级4例(15.4%),EngelⅢ级2例(7.7%),EngelⅣ级1例(3.8%)。多因素回归分析发现,存在头痛/头晕(OR:0.145,95%CI:0.029~0.719,P=0.018)、神经功能损伤(OR:0.025,95%CI:0.003~0.207,P=0.001)、颞叶肿瘤(OR:9.981,95%CI:1.829~54.453,P=0.008)是术前癫痫发作的显著预测因素;术前癫痫发作(OR:86.672,95%CI:3.356~2238.585,P=0.007)和手术切除程度(OR:0.034,95%CI:0.005~0.245,P=0.001)是术后癫痫发作的重要独立预测因素。结论存在头痛/头晕、神经功能损伤症状的患者术前癫痫发作率低,颞叶肿瘤位更易发作癫痫,术前存在癫痫发作的患者术后癫痫发作的危险性增加,肿瘤全切能够较好地控制癫痫发作症状。

Objective To investigate risk factors for pre-and postoperative seizures in patients undergoing resection of ganglioglioma in a single-institution.Methods Retrospective chart review of 58 subjects undergoing resection of ganglioglioma was performed at the author′s institution(1991-2018).These basic information included the number of cases,patient′s gender,age of diagnosis,sites of tumor,etc.Results Among 58 cases,30 subjects(51.7%)had preoperative seizures.Among 49 patients followed,26 cases had the history of preoperative seizure.Of these,Engel gradeⅠ,Ⅱ,Ⅲ,andⅣwas reported on 19 cases(73.1%),4(15.4%),2(7.7%),and 1(3.8%),respectively.Multivariate analysis identified accompanying symptoms of headache or dizzy(OR:0.145,95%CI:0.029-0.719,P=0.018),neurological deficit(OR:0.025,95%CI:0.003-0.207,P=0.001)and temporal tumors(OR:9.981,95%CI:1.829-54.453,P=0.008)decreased odds of preoperative seizures.Preoperative seizures(OR:86.672,95%CI:3.356-2238.585,P=0.007)was associated with postoperative seizures.Gross total removal(OR:0.034,95%CI:0.005-0.245,P=0.001)decreased odds of postoperative seizures.Conclusion Symptoms of headache or dizzy,neurological deficit and temporal tumors were important independent predictors of preoperative seizure.Gross total removal of ganglioglioma results in a better prognosis for postoperative seizures.