儿童脑肿瘤继发性癫疒间临床分析

摘要

Objective To explore the clinical features of the epilepsy secondary to brain tumors in children. Methods The clinical data of 38 patients with epilepsy secondary to brain tumors, including the growth site and pathology of the tumors, types of epileptic seizure, expression of electroencephalogram (EEG), the surgical treatment and prognosis, were analyzed retrospectively. Results Pediatric brain tumors leading to secondary epilepsy onset located mainly at the frontal and temporal lobes, while were relatively rare in the parietal lobe , occipital lobe , island leaves ( P< 0 . 05 ) . The neuronal and mixed neuronal-glial tumors were more common in pathological classification, followed by oligodendroglioma. Frontal lobe tumors caused mainly generalized tonic-clonic seizures, while temporal lobe tumors did complex partial seizures, there being a significant difference between the two types (P<0.05). Scalp EEG abnormalities presented mainly as the sharp wave or sharp-and-slow wave. The main surgical approach was total resection of the tumor and resection of epileptic foci. The patients were followed up for 3 to 15 months, recovery was achieved in 32 patients, tumor recurrence seen in 4, and death in 2. The prognosis of epilepsy achieved Engel Ⅰ in 28 patients and Engel Ⅱ-Ⅳ in 8. Conclusions The main brain tumors leading to epilepsy in children are benign tumors. Surgery is the most effective treatment. Resection of tumor and epileptogenic zone are more effective. For better clinical prognosis, the treatment strategy should be early resection of the tumor and epileptic foci.%目的 探讨儿童脑肿瘤继发性癫疒间的临床特征.方法 回顾性分析38例脑肿瘤继发癫疒间病儿的临床资料,包括致疒间脑肿瘤的生长部位、病理类型、癫疒间发作类型、脑电图表现、手术治疗方式以及预后等.结果 引起癫疒间发作的儿童脑肿瘤主要来源于额叶和颞叶,而顶叶、枕叶、岛叶相对少见(P<0.05).病理类型以神经元和混合性神经元-胶质肿瘤多见,其次为少突胶质细胞瘤.额叶肿瘤主要引起全身强直-阵挛性发作,颞叶肿瘤以复杂部分性发作为主,二者有显著差异(P<0.05).头皮脑电图异常主要表现为尖波或尖-慢波.手术方式以肿瘤全切加致疒间灶切除为主,术后随访3～15个月,治愈32例,肿瘤复发4例,死亡2例.术后癫疒间控制达到EngelⅠ级28例,EngelⅡ～Ⅳ级8例.结论 儿童继发性癫疒间发作的脑肿瘤以良性肿瘤为主,治疗策略应早期行肿瘤加致疒间灶切除手术,临床预后较好.