目的 总结脑膜血管瘤病的临床特点、治疗经验及预后.方法 回顾性分析广东三九脑科医院2016年6月-2021年1月期间收治的6例脑膜血管瘤病患者的临床资料,并结合相关文献进行复习.结果 6例患者中,临床发作表现为全身强直阵挛发作1例,部分发作继发全身强直阵挛发作5例.术中皮层监测提示所有患者病变部位有癫痫样放电,均在术中皮层脑电图监测引导下行病灶+病灶周围皮层致痫灶切除手术治疗.术后均给予抗癫痫药物治疗,术后Engel分级均为Ⅰ级,术后近期及远期均无明显并发症出现.结论 反复癫痫发作的患者,如果颅脑MRI提示长T1长T2异常信号影,T2 Flair呈内低外高信号影,T1增强可见部分强化,CT扫描提示,钙化病变应考虑脑膜血管瘤病的诊断可能.脑膜血管瘤病经过电生理评估和多学科讨论确定致痫区后,给予病灶和周围致痫区切除术,手术疗效好,术后复发风险低,所以脑膜血管瘤病伴癫痫患者可通过手术获得良好受益,早期手术受益远远大于风险.

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 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.

目的:探讨创伤性癫痫(postcrauimdc epilepsy,PTE)的流行病学特征、手术策略及效果分析.方法:回顾性分析71例PT E患者的临床资料,术前行详细术前评估,对未能精准定位致痫灶患者行立体定向脑电图(stereoelectroencephalography,SEEG)电极植入,对全面性癫痫无法行致痫灶定位者,先行胼胝体切开术,如术后转为局灶性发作则再次行术前评估切除致痫灶,而对于双侧致痫灶患者行迷走神经电刺激(vagus nerve stimulation,VNS)治疗.结果:一次性行致痫灶切除者36例,SEEG电极植入后行癫痫灶切除30例(其中2例为胼胝体切开术后患者),单纯胼胝体切开1例,VNS治疗4例.术后随访70例(1例失访),以14岁为年龄界限,分为儿童(≤14岁)和成人(>14岁).分为A组:儿童时期受伤,儿童时期手术25例,EngelⅠ级22例(88％);B组:儿童时期受伤,成人时期手术37例,EngelⅠ级20例(54％);C组:成人时期受伤,成人时期手术8例,EngelⅠ级7例(88％).A组和B组行Fisher检验,P<0.05,A组和C组、B组和C组Fisher检验,P>0.05,综合显示儿童受伤后儿童时期手术预后较成人时期手术好,而受伤年龄和癫痫手术预后无相关性.结论:外科手术是治疗PTE重要且有效的方法.术前详细评估,对于疑难患者行SEEG精准定位致痫灶,术后多数可得到满意的疗效.胼胝体切开、VNS也是PTE的重要辅助治疗方式.术后随访发现儿童患者儿童时期手术预后较成人时期好,所以对于药物难治性PTE儿童患者,建议尽早手术,以期尽早控制癫痫发作,避免患者神经功能受到二次损害,使其神经功能得到良好发育.

Objective To investigate the effectiveness and safety of stereoelectroencephalography (SEEG) in guiding surgical treatment of temporal-insular type of temporal plus epilepsy (TI-TPE).Methods A retrospective analysis was conducted on the clinical data of 10 TI-TPE cases confirmed by SEEG from May 2014 to November 2015 at Department of Epilepsy Center,Guangdong Sanjiu Brain Hospital.Those 10 patients accounted for 6.8％ of 147 surgical cases of temporal lobe epilepsy treated during the same period.Electrodes were implanted in all cases with the assistance of neurosurgical stereotactic robot.The epileptogenic zone,including the anterior temporal lobe,mesial temporal lobe and epileptic insular cortex,were surgically resected with SEEG guidance.The outcome was assessed to explore the effectiveness of operation.Results The number of electrodes implanted in each case was 9-16 (12.4 ±2.1) on average.Based on the SEEG results,7 cases were classified as simultaneous type and 3 as independent type.All cases underwent surgical operations.No complication was observed in this series except for 1 who had transient naming aphasia and recovered before discharge.As indicated by clinical follow-up of 18-36 (28 ±6) months on average,all cases reached Engel class Ⅰ post operation (9 cases of Ⅰa and 1 of Ⅰc).Conclusion SEEG is a significant method for the diagnosis of TI-TPE.For TI-TPE cases,surgical treatment with the guidance of SEEG seems safe and effective.

Objective To explore the safety of intracranial electrode implantation under help of Robotized stereotactic assistant (ROSA)-guided stereoelectroencephalography (SEEG) and its value to surgery for intractable epilepsy in children. Methods Nineteen children under 14 years of age with intractable epilepsy were preoperatively assessed by MRI, video-EEG, PET-CT and so on and then the implantation of intracranial electrode, by which the long-term intracranial EEG was recorded, was performed under the help of ROSA-guided SEEG in order to locate the epileptogenic zone. The surgery was performed after the location of the epileptogenic zone in all the patients. Results A total of 222 intracranial electrodes were successfully implanted in all the children. The electrodes were implanted in the left cerebral hemisphere in 11 children, in the right ones in 7 and in bilateral ones in 1. There were no complications such as bleeding, cerebrospinal fluid leakage, electrode fracture and infection in all the children after the implantation. The epileptogenic zones were exactly located and successfully resected by surgery in all the children. Two patients had transient hemiparesis after the surgery. The following up from 12 to 24 months showed that the epileptic control effect was Engel gradeⅠin 15 children, gradeⅡin 1, gradeⅢin 1 and gradeⅣin 2. Conclusions The intracranial electrode implantation under the help of ROSA-guided SEEG is safe and may decrease in the postoperative complications and improvement of prognosis in the children with intractable epilepsy.