幕上肿瘤伴发癫(癎)的精确定位和手术疗效分析

摘要

目的 探讨幕上肿瘤伴发癫(癎)的精确定位价值和手术治疗效果,研究肿瘤与致(癎)灶的关系.方法 对121例(胶质瘤Ⅰ级15例、Ⅱ级35例、Ⅲ～Ⅳ级12例,脑膜瘤32例,脑转移瘤10例,海绵状血管瘤15例,室管膜瘤2例)临床上以癫(癎)为首发症状的幕上肿瘤患者术前、术后癫(癎)发作情况等,临床资料进行回顾性分析.结果 采用术前影像和脑电结合定位、术中皮层脑电再次定位的方法,对肿瘤和癫(癎)灶同时切除,无手术死亡.癫(癎)发生率最高在额叶,最低在枕叶.癫(癎)灶与肿瘤的关系:位于同一部位者50例;致(癎)灶位于肿瘤一侧或近旁者28例;致(癎)灶位于肿瘤远隔部位(＞2 cm)25例;检测不到致痫灶者18例.失访18例,103例随访1～9年,31例术后早期仍有小发作,83例不再服抗癫(癎)药物癫(癎)症状完全消除.结论 在幕上肿瘤伴发癫(癎)患者中,致(癎)灶与肿瘤灶存在一定的差异性.在开颅切除肿瘤的同时必须明确致(癎)灶的位置和范围,一并切除才能达到良好的手术效果.%Objective To study the value and effectiveness of surgical management and mapping in supratentorial tumoral complicated with epilepsy and to study the correlations between tumor and the epileptogenic focus.Methods The clinical data of 121 patients with supratentorial cerebral tumor but epilepsy as initial symptom were retrospectively analyzed for the incidence of pre-and postoperative epileptic seizures,including grade Ⅰ glioma in 1 5 cases and grade Ⅱ glioma in 35 cases,grade Ⅲ-Ⅳglioma in 12 cases,menigoma in 32 cases,metastases in 10 cases,cavernous angiomas in 15 cases,and ependymomas in 2 cases.Results Surgery based on CT/MRI,seizure type and EEG changes was conducted.There was no death in operation.The highest incidence was in frontal lobe and the lowest in occipital lobe.Correlations between localization of tumor and the epileptogenic focus:there were 50 cases in the same location,near or beside tumors in 28 cases,far separate apart(＞2 cm)from tumors in 25 cases,no relationship was found in 18 cases.103 patients were followed up for one to nine years.31 patients had a few seizures in the early postoperative period.Epileptic seizures were cured without anti-epilepsy drugs in 83 cases.Conclusion There are some differences between tumors'location and epileptogenic focus in supratentorial tumoral epilepsy.The location and size of epileptogenic zone should be detected before and during operation.The resection of the tumor combined with the resection of the epileptogenic zone"epilepsy surgery"can provide good results.