低级别脑胶质瘤继发癫痫的外科治疗--附45例病例分析

Surgery for the treatment of low-grade glioma secondary epilepsy−analysis of 45 cases

目的探讨低级别脑胶质瘤继发癫痫的临床特点及手术治疗效果。方法回顾性分析2010年12月—2020年12月于武汉脑科医院神经外科行外科治疗的低级别脑脑胶质瘤继发癫痫的患者45例,其中男27例、女18例,年龄10~69岁,平均(42.8±15.61)岁。病程3月~5年,平均(12.5±4.12)个月,所有患者均以癫痫为首发症状,术前均行头部断层扫描(CT)及磁共振成像(MRI)检查,其中胶质瘤在额叶17例、颞叶12例、顶叶4例、同时累及额叶和颞叶7例、同时累及额叶和顶叶5例。病变在左侧有31例、右侧14例。术前长程视频脑电图检查提示致痫灶在一侧额叶20例、一侧颞叶8例、一侧额颞叶12例、一侧额顶叶5例。所有患者均在术中皮层脑电图(ECoG)监测行胶质瘤切除术,必要时加行致痫皮层扩大切除、皮层热灼或多处软脑膜下横纤维切断术(MST)。术后随访半年0.5~10年,平均(4.7±1.83)年,观察手术疗效。结果术中胶质瘤全切除42例、次全切除3例。其中19例累及颞叶的胶质瘤患者加行了前颞叶切除术,另外有13例加行皮层热灼术,5例加行MST。术后病理检测提示星形细胞瘤Ⅰ级20例、Ⅱ级12例、少突胶质细胞瘤11例、胚胎发育不良性神经上皮肿瘤2例。术后随访发现30例生存良好,12例复发,予再次手术,3例死亡。同时术后42例患者癫痫控制满意,无癫痫发作;另外3例仍时有癫痫发作,且术后服用两种抗癫痫药物效果均不佳。结论对于低级别胶质瘤继发癫痫患者,如果术前长程脑电图监测与影像学检查结果一致,应尽早在ECoG监测下行低级别胶质瘤切除加致痫灶切除,且术后效果一般均较好。

Objective To explore the clinical characteristics and surgical effect of low-grade glioma(LGG)secondary epilepsy.Methods 45 cases of low-grade glioma secondary epilepsy were retrospectively studied during December 2010 and December 2020.There were 27 males and 18 females in this group.Their ages ranged from 10 to 69 years[mean(42.8±15.61)years].And the illness duration ranged from 3 months to 5 years[mean(12.5±4.12)months].The initial manifestation of all LGG was seizure attack.All the patients underwent CT and MRI examination before the operation.The LGG was located in the frontal lobe in 17 cases,temporal lobe in 8 cases,parietal lobe in 4 cases,frontaltemporal lobe in 7 cases,frontal-parietal lobe in 5 cases.Meanwhile the LGG was located in the left side in 31 cases,right side in 14 cases.The long-term video-EEG monitoring showed the epileptogenic lesion was located in the ispilateral frontal lobe in 20 cases,temporal lobe in 8 cases,frontal-temporal lobe in 12 cases,frontal-parietal lobe in 5 cases.All the patients were performed operation under the intra-operative electrocorticography(ECoG)monitoring.If necessary,enlarged epileptogenic cortical resection,cortical coagulation or MST was added.After the operation,all the patients were followed-up for half a year to 10 years(mean 4.7±1.83 years)to observe the surgical effect.Results 42 cases of LGG underwent gross total resection and 3 subtotal resection intra-operatively.Anterial temporal lobectomy(ALT)was added in 19 cases whose LGG were invovled with temporal lobe.13 cases were added cortical cogulation and 5 cases MST.The post-operative pathology showed astrocytoma gradeⅠin 20 cases,astrocytoma gradeⅡin 12 cases,oligodendroglioma in 11 cases and dysembryoplastic neuroepithelial tumor(DNET)in 2 cases.The post-operative follow-up showed that 30 cases lived well,12 cases recurred and received re-operation,3 cases died.Meanwhile,42 cases were seizure free and 3 cases had occasional seizure attack during the follow-up.Conclusions To the patients with LGG secondary epilepsy,if pre-operative long-term EEG monitoring is in accordance with imaging examination,early LGG resection combined with epileptogenic lesion resection should be performed under the guidance of ECoG monitoring.And the post-operative effect is satisfactory.