以中央前回中断为特征的局灶性皮质发育不良患者的影像学特点及手术治疗

Imaging features and surgical treatment of patients with focal cortical dysplasia characterized by interrupting precentral gyrus

目的分析以中央前回中断为特征的局灶性皮质发育不良(FCD)患者的影像学特征,并探索该病的手术治疗策略。方法选取2015年1月至2021年12月在北京天坛-丰台癫痫中心行手术治疗,病理或影像结果提示为FCD,影像学表现为中央前回中断的药物难治性癫痫患者,收集患者的影像学资料,以及病史、查体、头皮脑电图、核磁共振、正电子发射型计算机断层显像、立体脑电图、术中情况、病理及术后随访等病例资料。结果共纳入5例FCD患者,所有患者头颅MRI均示中央前回被畸形脑沟横断,其中1例患者伴有灰白质交界模糊,2例伴有穿透征的异常表现。5例患者PET-CT均提示畸形脑沟代谢减低。其中4例患者接受了以畸形脑沟为中心的局灶性灰质切除,1例接受热凝治疗。病理检查发现4例标本均为Ⅱ型FCD,其中ⅡA与ⅡB各2例。行切除术的4例患者术后随访1~4年均无癫痫发作。结论中央前回中断的影像学特点可能是中央区Ⅱ型FCD患者的特征性表现,局限性切除该脑沟的灰质可获得较好的治疗效果。

Objective To investigate the imaging features of patients with focal cortical dysplasia(FCD)characterized by interrupting precentral gyrus and explore the surgical strategy.Methods At Beijing Tiantan-Fengtai Epilepsy Center from January 2015 to December 2021,patients with drug-refractory epilepsy,surgical treatment,whose pathological or imaging results showing FCD,and whose imaging manifestations showing interruption of the precentral gyrus were selected.The data of the patients was documented,including imaging data,medical history,physical examination,scalp EEG,magnetic resonance imaging,positron emission computed tomography,stereoelectroencephalography,intraoperative condition,pathology and postoperative follow-up,etc.Results A total of 5 patients with FCD were included.Head MRI showed that all patients had the precentral gyri transected by the malformed sulcus.Among them,there was 1 patient with blurred gray-white matter junction,2 patients with abnormal manifestations of transmantle sign.There were 5 patients with reduced metabolism of the malformed sulcus revealed by PET-CT.4 patients with sulcus-centered resection and 1 patient with radiofrequency-thermocoagulation.Pathological examination showed that 4 specimens were all typeⅡFCD,including 2ⅡA and 2ⅡB.Four patients who underwent resection were followed up for 1 to 4 years without epileptic seizure.Conclusion Imaging characteristics of interrupting precentral gyrus may be unique for patients with typeⅡFCD in the central region.Focal excision of the gray matter of the sulcus can achieve better therapeutic effect.