Accurate detection and resection of the epileptogenic zone (EZ) in patients with long-term epilepsy-associated tumors (LEATs) are significantly correlated with favorable seizure prognosis. However, the relationship between tumors and the EZ remains unknown. This study aimed to evaluate the spatial relationship between LEATs and the EZ, as well as the electrophysiological features of LEATs. We retrospectively studied five patients with LEATs who underwent deep electrode implantation and EZ resection in the hospital. The clinical characteristics, surgical outcomes, localizing features and intracranial SEEG results were reviewed. One female and four males (mean age: 25.2 years; median age: 24 years; range: 13–45 years) were included in the study. Five-to-eleven electrodes (mean: 8.4) were implanted per patient. The EZ was located in the tumor and nearby cortex in three cases and in the tumor and distant areas in two cases. Pathological examination revealed ganglioglioma in four cases, two of which were associated with hippocampal sclerosis, and the other case showed a multinodular and vacuolating neuronal tumor with gliosis. All patients were seizure-free for at least 24 months postoperatively. SEEG provides valuable insights into the electrophysiological mechanisms of LEATs. The EZ often contains brain tissue around the tumor. However, only a few cases, particularly those with temporoparietal occipital (TPO) area involvement, a long history of epilepsy and other abnormalities on MRI, such as hippocampal sclerosis and focal cortical dysplasia, may include distant areas.

Background The lack of a well-designed brain tumour registry with standardized pathological diagnoses in underdeveloped countries hinders the ability to compare epidemiologic data across the globe. The National Brain Tumour Registry of China (NBTRC), created in January 2018, is the first multi-hospital-based brain tumour registry in China. Patient data reported to the NBTRC in years 2019-2020 were assessed.Methods Tumour pathology was based on the 2016 World Health Organization (WHO) classification of tumours of the central nervous system and ICD-O-3. The anatomical site was coded per the Surveillance, Epidemiology, and End Results (SEER) solid tumour module (version of July 2019). The cases were tabulated by histology and anatomical site. Categorical variables were reported as numbers (percentages). The distribution of tumours by age (0-14, 15-19, 20-39, 40-64, and 65+ years) was analysed.Findings There were a total of 25,537 brain tumours, foremost among them meningioma (23.63%), followed by tumours of the pituitary (23.42%), and nerve sheath tumours (9.09%). Glioblastoma, the most common and lethal form of primary brain cancer in adults, represented 8.56% of all cases. Of note, 6.48% of the malignant tumours were located in the brain stem. The percentage of malignant brain tumours decreased with increasing age, 24.08% in adults (40+ years), 30.25% in young adults (20-39 years), 35.27% in adolescents (15-19 years), and 49.83% in children (0-14 years). Among the 2107 paediatric patients, the most common sites were ventricle (17.19%), brainstem (14.03%), pituitary and craniopharyngeal duct (13.4%), and cerebellum (12.3%), a distribution that differed from that of the entire cohort. The histology distribution was also unique in children, with glioblastoma much less incident compared to the whole cohort (3% vs. 8.47%, p < 0.01). 58.80% of all patients chose higher-level neurosurgical hospitals outside of their province of residence. The median in-hospital length of stay (LOS) for the various pathologies ranged from 11 to 19 days.Interpretation The histological and anatomical site distribution of brain tumours in the NBTRC was statistically different in the subgroup of children (0-14 years). Patient choice of pursuing trans-provincial treatment was common and the in-hospital LOS was longer compared to that reported in similar European and American patient populations, which merits further attention.Funding The National Key Research and Development Program of China (2015BAI12B04, 2013BAI09B03, 2014BAI04B01, and 2021YFF1201104) and Chinese National Natural Science Foundation of China (81971668).Copyright & COPY; 2023 Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http:// creativecommons.org/licenses/by-nc-nd/4.0/).

It is well-known that genomic mutational analysis plays a significant role in patients with NSCLC for personalized treatment. Given the increasing use of stereotactic radiosurgery (SRS) for brain metastases (BM), there is an emerging need for more precise assessment of survival outcomes after SRS. Patients with BM and treated by SRS were eligible in this study. The primary endpoint was overall survival (OS). Cox regression models were used to identify independent prognostic factors. A survival predictive nomogram was developed and evaluated by Concordance-index (C-index), area under the curve (AUC), and calibration curve. From January 2016 to December 2019, a total of 356 BM patients were eligible. The median OS was 17.7 months [95% confidence interval (CI) 15.5–19.9] and the actual OS at 1- and 2-years measured 63.2 and 37.6%, respectively. A nomogram for OS was developed by incorporating four independent prognostic factors: Karnofsky Performance Score, cumulative tumor volume, gene mutation status, and serum lactate dehydrogenase. The nomogram was validated in a separate cohort and demonstrated good calibration and good discriminative ability (C-index = 0.780, AUC = 0.784). The prognostic accuracy of the nomogram (0.792) was considerably enhanced when compared with classical prognostic indices, including the Graded Prognostic Assessment (0.708), recursive partitioning analysis (0.587), and the SRS (0.536). Kaplan–Meier curves showed significant differences in OS among the stratified low-, median- and high-risk groups (P < 0.001). In conclusion, we developed and validated an individualized prognostic nomogram by integrating physiological, volumetric, clinical chemistry, and molecular biological surrogates. Although this nomogram should be validated by independent external study, it has a potential to facilitate more precise risk-stratifications to guide personalized treatment for BM.

BackgroundMolecular characteristics are essential for the classification and grading of gliomas. However, diagnostic classification of midline glioma is still debatable and substantial molecular and clinical heterogeneity within each subgroup suggested that they should be further stratified. Here, we studied the mutation landscape of Chinese midline glioma patients in hope to provide new insights for glioma prognosis and treatment.MethodsTissue samples from 112 midline glioma patients underwent next-generation sequencing targeting 425 cancer-relevant genes. Gene mutations and copy number variations were investigated for their somatic interactions and prognostic effect using overall survival data. Pathway-based survival analysis was performed for ten canonical oncogenic pathways.ResultsWe identified several currently established diagnostic and prognostic biomarkers of glioma, including TP53 (33%), EGFR (26%), TERT (24%), PTEN (21%), PIK3CA (14%), ATRX (14%), BRAF (13%), and IDH1/2 (6%). Among all genetic aberrations with more than 5% occurrence rate, six mutations and three copy number gains were greatly associated with poor overall survival (univariate, P < 0.1). Of these, TERT mutations (hazard ratio [HR], 3.00; 95% confidence interval [CI], 1.37–6.61; P = 0.01) and PIK3CA mutations (HR, 2.04; 95% CI, 1.08–3.84; P = 0.02) remained significant in multivariate analyses. Additionally, we have also identified a novel MCL1 amplification (found in 31% patients) as a potential independent biomarker for glioma (multivariate HR, 2.78; 95% CI, 1.53–5.08; P < 0.001), which was seldom reported in public databases. Pathway analyses revealed significantly worse prognosis with abnormal PI3K (HR, 1.81; 95% CI, 1.12–2.95; P = 0.01) and cell cycle pathways (HR, 1.97; 95% CI, 1.15–3.37; P = 0.01), both of which stayed meaningful after multivariate adjustment.ConclusionsIn this study, we discovered shorter survival in midline glioma patients with PIK3CA and TERT mutations and with abnormal PI3K and cell cycle pathways. We also revealed a novel prognostic marker, MCL1 amplification that collectively provided new insights and opportunities in understanding and treating midline gliomas.

PURPOSE:This study aimed to evaluate the clinical features, prognostic factors, and survival outcomes for patients with intracranial nongerminomatous germ cell tumors (NGGCTs), with a particular focus on treatment toxicity for long-term survivors. METHODS:Intracranial NGGCTs treated with platinum-based chemotherapy and craniospinal irradiation (CSI) in our institution were retrospectively analyzed. Hematological complications following sequential chemoradiotherapy as well as height and weight in childhood survivors were evaluated. Plasma growth hormone (GH) concentrations prior to and after radiotherapy were obtained for the comparisons. RESULTS:A total of 111 intracranial NGGCTs were included. The 3‑year overall survival (OS) and event-free survival (EFS) rates were 83.5% ± 3.9% and 71.0% ± 4.8%, respectively. A combined treatment modality consisting of ≥ 4 cycles of platinum-based chemotherapy and CSI was associated with an improved OS (P = 0.003) and EFS (P < 0.001). Thrombocytopenia of any grade occurred in 35.4% (34/96) of patients, and the threshold age for an increased risk of thrombocytopenia was 14 years (area under the curve AUC = 0.752, P < 0.0001) as derived from receiver operating characteristic (ROC) analysis. Growth impediment was found in 8 of 56 (14%) patients. The age for receiving radiotherapy was found to inversely correlate with height development, revealing a cut-off age of 11.5 years for risking growth impairment (AUC = 0.806, P = 0.004). Consistently, a significant decline in plasma growth hormone after radiotherapy was observed in patients ≤ 11.5 years (P < 0.01) but not patients > 11.5 years. (P > 0.05). CONCLUSION:Our study suggested that a combined treatment modality with at least four cycles of chemotherapy and CSI was safe and effective for patients with intracranial NGGCTs. Radiotherapy should be used with caution for patients < 11.5 years due to growth impairment.

Objective:To explore the efficacy and safety of conformal radiofrequency thermocoagulation (RF-TC) guided by stereo-electroencephalography (SEEG) based on three-dimensional images for the treatment of epilepsy caused by focal cortical dysplasia (FCD).Methods:A retrospective study was conducted on the clinical data of 19 patients with drug-refractory epilepsy admitted to the Epilepsy Centre of Guangdong Sanjiu Brain Hospital from September 2017 to December 2019. The lesion in all patients was confirmed to be FCD and had clear boundaries based on preoperative evaluation including imaging and electroencephalography. The maximum diameter of lesions ranged from 1.4 cm to 4.0 cm with an average of 2.3±0.7 cm. All patients underwent SEEG electrode placement. During the design of electrode placement scheme, the software of 3D-Slicer was used to reconstruct the three-dimensional MRI images and the lesions were tried to be covered by the SEEG electrode contacts as much as possible. RF-TC was performed to ablate the lesion. Regular follow-up was performed post operation. The modified Engel classification was used to evaluate the outcome of seizure control.Results:In 19 patients, 9±2 SEEG electrodes/case (6-12 electrodes/case) were implanted, and the number of electrodes passing through the lesion was 5±2/case (2-8/case). The RF-TC target points during treatment were 25±13/case (6-52/case), and RF-TC was completed in 1 to 4 times/case. Eight patients experienced temporary muscle strength decline after operation, but all recovered completely before being discharged from the hospital. All 19 patients were followed up for 17±8 months (6-33 months). At the last follow-up, there were 16 cases classified as grade Ⅰ, 2 cases as grade Ⅱ, and 1 case as grade Ⅲ based on the modified Engel classification. None of the patients had permanent neurological deficits.Conclusion:For patients with drug-refractory epilepsy caused by FCD with established epileptogenicity, clear boundaries and limited scope, the SEEG-guided conformal thermocoagulation based on three-dimensional imaging has few complications and a good prognosis.

目的 研究颞叶外节细胞胶质瘤(GG)继发癫痫的临床特点和手术治疗方式及疗效.方法 回顾性分析手术治疗并经病理证实的20例颞叶外节细胞胶质瘤继发癫痫患者的临床资料.术后癫痫控制效果按改良Engel分级标准评定;分析患者的发作表现、病变部位、影像学特点、病理改变、手术方式及病变切除程度与癫痫控制的关系.结果 节细胞胶质瘤位于额叶者2例、顶叶7例、枕叶5例、颞枕交界处6例.MRI检查显示肿瘤为囊性者5例、囊实性6例、实性9例;增强扫描病变有强化12例,病变周围水肿5例.CT检查示病变有钙化4例.癫痫发作表现为简单部分性发作(伴意识保留的局灶性发作)者4例,复杂部分性发作(伴意识障碍的局灶性发作)5例,继发性全面性强直阵挛(局灶进展到双侧的强直阵挛发作)11例.肿瘤次全切除者2例,全切除15例,扩大切除3例.术后病理检查示合并脑皮质发育不良者2例.术后随访1～3年,癫痫控制效果为Engel Ⅰ级17例(85.0％),Ⅱ级2例(10.0％),Ⅲ级1例(5.0％).预后相关临床因素分析显示,肿瘤切除的方式和程度与预后有关.结论 颞叶外节细胞胶质瘤继发癫痫多为药物难治性,手术切除可取得良好效果.术前须综合评估病变部位和临床、影像学特点等资料制定手术策略,术中尽可能行肿瘤加致痫皮层全切除,以提高疗效.必要时可考虑先行SEEG电极植入后,再行致痫灶精准切除术.

目的 探讨经颅多普勒超声(TCD)联合体感诱发电位(SEP)监测在颈动脉内膜剥脱(CEA)术中的应用价值.方法 对29例颈动脉狭窄患者在CEA术中采用TCD和SEP联合监测,用TCD监测术侧大脑中动脉(MCA)平均血流速度(Vm)的变化,并记录同时段SEP波幅的变化.根据术中TCD和SEP的变化综合判断是否实施转流术,并判断开放颈动脉后有无出现脑血流高灌注.结果 本组患者经术中应用TCD和SEP联合监测均顺利完成手术;3例TCD监测MCA Vm及SEP波幅下降均达到转流标准的患者,术中行转流术.SEP(10.3％,3/29)和TCD(44.8％,13/29)监测达到转流标准比率的差异有统计学意义(X2 =4.118,P=0.002).5例患者TCD监测示术中出现脑血流过度灌注,但此时SEP并无阳性表现,通过适当降血压及压迫颈动脉处理,其中仅1例患者术后出现脑过度灌注综合征.本组患者术后1周内复查CTA或DSA显示颈动脉狭窄均消失.术后随访3～18个月,仅1例患者在术后第10 d出现术侧手功能区小片状脑梗死,其他患者均无出现并发症.结论 TCD与SEP联合监测在CEA术中具有较高的临床应用价值;SEP在判断术中是否使用转流方面更有优势,TCD在判断CEA术中高灌注方面有优势.

Objective:To explore the clinical characteristics, diagnostic methods, treatment strategies, and curative efficacies of epilepsy secondary to cerebral sparganosis.Methods:A retrospective analysis on clinical data of 62 patients with epilepsy caused by cerebral sparganosis diagnosed in our hospital from July 2004 to May 2019 was performed. According to the treatment intention of the patients, these patients were divided into surgery group ( n=39) and drug deworming group ( n=23). Patients in the surgery group were treated with craniotomy assisted by navigation to remove worms and lesions, and patients without live worms were treated with lesion resection or cortical burning. Patients in the drug deworming group were treated with praziquantel at a dose of 60 mg/(kg·d) with 10 d as a course of treatment; the next course of treatment was followed at an interval of 2 months, and ended until the standard of cure was achieved. All patients were followed up for 1-8 years, and the prognoses were determined according to the imaging data, clinical symptom improvement and sparganosis antibody IgG detection results. The epilepsy control 1 year after treatment was assessed by modified Engel grading. Results:Live worms were removed from 34 patients of the surgery group, with a total of 35 worms; after 1-8 years of follow-up, 34 patients were cured and 5 patients were not cured in the surgery group; however, 7 patients were cured and 16 patients were not cured in the drug deworming group; the cure rate in the surgery group was signficantly higher than that in the drug deworming group ( P=0.000). Modified Engel grading I was achieved in 36 patients, grading II in 2 patients, grading III in 0, and IV in 1 patient of the surgery group; modified Engel grading I was achieved in 9 patients, grading II in 3, grading III in 5, and grading IV in 6 patients of the drug deworming group; significant differences were noted between the two groups ( Z=203.000, P=0.000); the mean rank suggested that the surgery group had better efficacy than the drug deworming group(25.21 vs. 42.17). Conclusion:The successful surgical removal of live worms with the help of modern neurosurgery technology has better efficacy than drug deworming treatment in the epilepsy secondary to cerebral sparganosis.

目的 探讨胚胎发育不良性神经上皮肿瘤(DNT)继发癫痫的临床特点和手术疗效.方法 回顾性分析2014年12月至2019年1月手术治疗并经病理证实的53例DNT合并癫痫的临床资料.结果 肿瘤次全切除9例,全切除23例,扩大切除21例.术后病理检查结果均为DNT,其中合并局灶性脑皮质发育不良20例、海马硬化4例、神经节细胞胶质瘤4例.术后随访1～3年,Engel分级Ⅰ级43例(81.1％;其中MRI分型Ⅰ型29例,Ⅱ型11例,Ⅲ型3例),Ⅱ级4例(7.5％),Ⅲ级4例(7.5％),Ⅳ级2例(3.8％);术后复查MRI未见肿瘤复发或进展.结论 DNT继发癫痫多为药物难治性癫痫,手术切除可取得良好效果.术前需综合评估病变部位和影像学特点等制定相应的手术方案,术中尽可能全切肿瘤,有助于提高手术疗效.

目的 探讨脑裂头蚴病的手术疗效.方法 回顾性分析58例确诊并行手术治疗的脑裂头蚴病病例的临床资料,均显微镜下切开皮质探查病灶、寻找虫体.结果 在58例手术病人中,取出虫体45例(取出虫体46条),未取出虫体13例.随访时间6～96个月,取出虫体的45例和未取出虫体的8例均显示病灶强化影消失,脑内其他部位未见新发病灶.另5例未取出虫体者出现新发病灶,提示仍有活虫存留.脑裂头蚴病伴癫痫病例,术后改良Engel分级,两组差异具有统计学意义(P<0.05),表明手术取出虫体对癫痫的疗效优于未取出虫体者.其他症状均未因手术而加重,无死亡病例.结论 脑裂头蚴病外科手术治疗安全,完整取出虫体能够获得较好疗效.

目的 研究额眶回癫疒间的电临床症状学特点和手术疗效.方法 回顾性分析10例经立体定向脑电图(stereotactic electroencephalogram,SEEG)确诊为额眶回癫疒间的病例资料,总结头皮脑电图、发作症状学、影像学特点及SEEG监测结果的特点.所有病人行致疒间区切除,采用改良Engel分级评估病人术后癫疒间控制情况.结果 术前头皮脑电图显示:10例间期放电均位于一侧额颞区.SEEG监测提示:发作起始区均位于额眶区,其中7例早期扩散至前扣带回或岛叶而表现为过度运动性发作,2例扩散至颞岛叶而表现为自动运动性发作,1例扩散至额叶而表现为简单运动性发作.行额眶回致疒间灶切除8例,扩大切除2例.术后随访2～5年,癫疒间控制达EngelⅠ级8例,Ⅱ级1例,Ⅲ级1例.致疒间灶病理为结节性硬化1例,脑软化2例,FCDⅡa 2例,FCDⅡb 2例,FCDⅠb 3例.术后均未遗留明显功能障碍.结论 额眶回癫疒间间期放电常位于一侧额颞区,以复杂运动性发作为主,因早期扩散区不同导致不同的症状学表现.手术切除致疒间灶时,需警惕额眶回癫疒间附加症的可能.

目的 总结SEEG引导下射频热凝毁损术治疗药物难治性癫痫的手术疗效及治疗体会.方法 对我科2016年12月至2018年5月进行SEEG引导下射频热凝毁损术治疗的13例药物难治性癫痫患者的临床资料进行回顾性分析,并复习相关文献.结果 本组纳入病种包括下丘脑错构瘤,侧脑室壁灰质异位结节及其他皮质发育异常.行SEEG引导下射频热凝毁损术后有7例出现短期并发症:3例偏瘫,2例发热、1例中枢性面瘫,1例视物模糊,出院时均完全恢复.术后常规服用抗痫药物,经过3个月至21个月的随访,10例患者Engle工级,2例EngleⅡ级,1例EngleⅣ级.发作未完全控制患者均再次行开颅手术切除致痫灶,病理分别为FCDⅡa型、MCD(大脑发育畸形)、灰质异位,疗效进一步随访中.结论 SEEG引导下射频热凝毁损术是癫痫外科治疗方案中的一项有力补充,选择合适的病例进行射频热凝毁损术安全有效,甚至可以达到无发作.

目的 研究神经内镜下大脑半球离断术的有效性和安全性.方法 回顾性分析1例药物难治性癫疒间病人的临床资料,采用神经内镜下大脑半球离断术,分析其术后疗效和并发症.结果 术后MRI提示左侧基底核区与周围脑叶完全离断,DTI提示各脑叶与基底核区无纤维传导束联系.术后2周内有发热,予腰大池置管引流后控制;无其他并发症.随访6个月,无癫疒间发作,达EngelⅠ级;神经认知功能较术前改善.结论 对药物难治性癫疒间行神经内镜下大脑半球离断术安全、微创、有效.

OBJECTIVE:To explore the strategy of surgical treatment of low-grade brain tumors associated with epilepsy.METHODS:Clinical data of 158 patients with low-grade brain tumors were collected from January 2011 to December 2017 in Guangdong Sanjiu brain hospital. All patients received Preoperative evaluation. Lesion site: 18 cases were located in multiple cerebral lobes, 10 cases were in the functional zones, 130 cases were in the non-functional zones (including 74 cases were in the medial of temporal lobe). The surgical strategy included subtotal resection, gross-total resection and enlarged resection. Postoperative effects were evaluated by Engel classification.RESULTS:A total of 158 patients underwent surgical treatment, among these patients, only 1 patient underwent intracranial electrode implantation. Surgical methods: 34 cases of subtotal resection, 3 cases of gross-total resection, 119 cases of enlarged resection (including Anterior temporal lobectomy in 74 cases) and 2 case of Selective hippocampal amygdalectomy. The final pathology suggested that there are 74 cases of ganglionglioma, 25 cases of dysembryoplastic neuroepithelial tumors, 9 cases of pilocytic astrocytoma, 16 cases of oligodendroglioma, 10 cases of pleomorphic xanthoastrocytoma, 4 case of diffuse astrocytoma, 9 cases of unclassified astrocytoma, 11 case of oligoastrocytoma. The follow-up time was between 1 and 7 years, with an average of 3.44±1.77 years. Postoperative recovery: 147 patients had an Engel Class I outcome, 10 patients were in Engel Class II, 1 patient was in Class IV.CONCLUSION:The strategy of surgical treatment of low-grade brain tumors associated with epilepsy should pay more attention to the preoperative assessment of the epileptogenic zone. The tumor is not exactly the same as the epileptogenic zone, and the strategy of surgical treatment depends on the tumor feature as well as whether it was located in temporal lobe or involved in functional areas.

Background and purpose Leptomeningeal metastasis (LM) is a rare but detrimental complication in patients with non-small cell lung cancer (NSCLC). Although whole brain radiotherapy (WBRT) is used to eliminating cancer cells or microscopic foci, it is becoming less favorable due to the concerns over neurocognitive toxicity. This study aimed to re-evaluate the role of WBRT in the setting of modern targeted therapy. Materials and methods From December 2014 to March 2019, 80 NSCLC patients with cytologically and/or radiologically proven LM diagnosis were retrospectively analyzed. Results The median OS (mOS) after diagnosis of LM was 8.0 (95%CI: 4.4 to 11.6) months, and the one-year OS was 39.4%. The mOS for EGFR-mutated LM patients was 12.6 (3.0 to 22.2) months versus only 4.1 (2.8 to 5.4) for patients with wild-type EGFR ( P < 0.001). Younger patients (< 53.5 yrs.) appeared to have a better OS than older patients (≥53.5 yrs.) (12.6 vs. 6.1, P = 0.041). No survival benefits were found in EGFR-mutated patients who received WBRT ( P = 0.490). In contrast, mOS was significantly prolonged in wild-type EGFR patients with WBRT versus non-WBRT (mOS: 8.0 vs. 2.1, P = 0.002). Multivariate analysis indicated that WBRT ( P = 0.025) and younger age ( P = 0.048) were independent prognostic factors that predicted prolonged survival for wild-type EGFR LM patients from NSCLC. Conclusion Our study demonstrated that WBRT has clear survival advantages for patients with wild-type EGFR, and molecular biological stratification of LM patients for WBRT is highly recommended.

目的 研究胼胝体全段切开术治疗药物难治性癫(癇)的安全性和有效性,并探讨其在二期切除性手术的作用.方法 回顾性分析40例药物难治性癫(癇)病例资料,发作类型:强直发作31例,跌倒发作14例,痉挛发作5例,强直-阵挛发作3例和肌阵挛发作3例.经术前评估后行胼胝体全段切开术,术后定期随访癫(癇)控制情况,癫(癇)控制疗效不佳者再行二期手术评估.结果 术后随访1～3年,癫(癇)控制达到EngelⅠ级10例,Ⅱ级11例,Ⅲ级12例,Ⅳ级7例,手术总有效率达82.5％;结果显示:跌倒发作和强直发作减少明显.术后并发症:急性失连接综合征4例,硬膜下积液3例,硬膜下积血1例,经相应处理后恢复正常.术后韦氏智力与记忆力较术前改善(均P<0.05).术后间歇期脑电图(electroencephalogram,EEG)转化为一侧癫(癇)样放电为主29例(72.5％),癫(癇)发作能定侧13例(32.5％).6例病人经再次评估后行二期致(癇)灶切除术,二期手术后癫(癇)无发作.结论 胼胝体全段切开术是一种治疗药物难治性癫(癇)安全有效的方法,同时还可改善病人神经认知功能,且有助于二期致(癇)灶切除术的术前评估定位,但需要严格把握适应证.

Objective To explore the surgical strategies for low-grade glioma and mixed neuron glioma-related epilepsy.Methods The clinical data of 171 patients with low-grade glioma and mixed neuronal glioma-related epilepsy who underwent surgery from 2011 to 2017 in Department of Epilepsy Surgery , Guangdong Sanjiu Brain Hospital were analyzed retrospectively.And the related literatures were reviewed.Results 169 patients underwent non-invasive stage I assessment and obtained resections under the intraoperative cortical electrode monitoring.2 patients underwent SEEG monitoring to determine the extent of epileptogenic zone and then received craniotomy. Patients with neoplastic lesions involving the functional area underwent surgery with intraoperative awakening.32 cases were lesion subtotal resection , and only 6 were lesion total resection.The remaining patients had a larger resection range than the tumor lesions.All patients had no surgical complications such as neurological dysfunction , intracranial infection, and hematoma.Every patient took anti-epileptic drugs after surgery.After 1 to 7 years of follow-up, 149 patients obtained EngleⅠlevel, 19 obtained Engle Ⅱ level, 1 obtained Engle Ⅲ level, 2 obtained Engle Ⅳ level. Conclusions Surgical treatment of low-grade glioma and neuronal mixed glioma-related epilepsy is an important part of epilepsy surgery.It should be evaluated reasonably according to the preoperative evaluation procedure of epilepsy surgery , and individualized surgical strategy can improve the patients’prognosis and quality of life according to the specific situation.

To summarize the diagnosis of tuberous sclerosis and the surgical treatment of its related drug-refractory epilepsy.Methods The clinical data of 10 patients of tuberous sclerosis complicated with drug-refractory epilepsy underwent surgical treatment from April 2015 to July 2018 in Guangdong Sanjiu Brain Hospital were analyzed retrospectively and related literatures were reviewed.In this group of patients, two strategies were proposed for the treatment of epileptogenic foci: direct epithelial cortical electrode monitoring and SEEG monitoring. Results The lesions in patients with tuberous sclerosis involved multiple systems and could cause complex clinical manifestations.The involvement of the nervous system was mainly characterized by drug-refractory epilepsy and cognitive impairment.The types of seizures could be diverse.The EEG showd focal or multifocal spike-slow waves in one hemisphere , or multifocal spike-slow waves in multiple hemisphere or even comprehensive spike-slow waves.MRI showed multiple abnormal signals in the cortex, subcortex and subependymal membrane.Subependymal giant cell astrocytoma could be seen occasionally , while CT examination showed calcification.After 3 months to 3 years and a half of follow-up, all patients were all Engle I grade , except one patient Engle III grade.Conclusions It is not difficult to diagnosis with tuberous sclerosis , according to the clinical manifestations of patients and combining with genetic and imaging examinations.Choosing the right case for active surgical treatment can achieve good results for the tuberous sclerosis patients with drug -refractory epilepsy.

儿童低级别肿瘤往往合并顽固性癫痫,严重影响患儿生活质量.外科治疗的目的应兼顾肿瘤治疗、发作控制与神经功能保护三个方面.在肿瘤全切除的基础上进一步切除致痫灶,往往能更好地控制发作.在手术切除范围的设计上,应综合考虑肿瘤部位(颞叶或颞叶以外、功能或非功能区等)、肿瘤性质、癫痫术前评估结果、患儿自身功能状态及家庭收入水平等因素.