MRI成像阳性癫痫患儿手术效果及其预后因素

发布时间：2019-05-23 01:40

【摘要】：目的：报道MRI阳性癫痫患儿手术疗效，探讨影响MRI阳性癫痫患儿手术预后的相关因素。方法：本研究对在2005年6月-2009年9月经手术治疗并能进行1年以上随访的的58名MRI阳性癫痫患儿进行了回顾分析。根据术前视频脑电图（VEEG）、MRI、正电子发射计算机断层显像和计算机断层扫描(PET-CT)、侵入性脑电(InvasiveEEG,IEEG)等评估结果确定致痫灶部位和手术方案。手术中尽可能全切病灶和致痫灶。术后根据Engel分级法将患儿分为未见发作（Engel等级Ⅰ级）与有发作组（Engel等级II-IV级），对可能影响手术预后的因素包括手术年龄，病程，首发年龄，发作频率，发作类型，致痫灶部位，MRI与VEEG定位一致性等进行统计分析。结果：39例（67.2%）MRI阳性癫痫患儿术后未见发作，其中17例（73.9%）颞叶萎缩或海马硬化，11例（91.7%）低级别肿瘤，4例（66.7%）蛛网膜囊肿，3例（42.9%）皮质发育不良,2例（100%）海绵状血管瘤，2例（25.0%）软化灶患儿未见发作。在术后有发作的19例患儿中，4例(6.9%)极少发作；7例(12.1%)发作减少90%；8例(13.8%)发作未见明显减少。统计学分析表明病程短，非继发全面性发作类型，，发作频率低，MRI与VEEG定位一致的MRI阳性癫痫患儿手术效果好。手术年龄，首发年龄，致痫灶部位与癫痫患儿手术效果没有显著性关系。结论：MRI阳性癫痫患儿手术效果良好，对MRI阳性癫痫患儿应早期手术治疗。根据患儿在手术治疗过程中的临床因素及诊断结果等可以对手术效果进行预测。
[Abstract]:Objective: to report the surgical effect of MRI positive epileptic children and to explore the related factors affecting the surgical prognosis of MRI positive epileptic children. Methods: from June 2005 to September 2009, 58 children with MRI positive seizures who were treated surgically and were followed up for more than one year were analyzed retrospectively. The location and surgical scheme of epileptic foci were determined according to the results of preoperative video electroencephalogram (EEG) (VEEG), MRI, Positron emission tomography (PET-CT), invasive EEG (InvasiveEEG,IEEG) and so on. The lesions and epileptic foci were cut as completely as possible during the operation. According to Engel classification, the children were divided into two groups: no attack (Engel grade I) and attack group (Engel grade II-IV). The factors that might affect the prognosis of the operation included operation age, course of disease, age of first onset, frequency of attack and type of attack. The location of epileptic foci and the consistency of MRI and VEEG localization were statistically analyzed. Results: no seizures were found in 39 cases (67.2%) of MRI positive epileptic children, including 17 cases (73.9%) of temporal lobe atrophy or hippocampal sclerosis, 11 cases (91.7%) of low grade tumors and 4 cases (66.7%) of arachnoid cysts. Cortical dysplasia was found in 3 cases (42.9%), cavernous angioma in 2 cases (100%) and softened foci in 2 cases (25.0%). Of the 19 children with postoperative seizures, 4 (6.9%) had very few seizures, 7 (12.1%) had a 90% decrease in seizures and 8 (13.8%) had no significant decrease. Statistical analysis showed that MRI positive epileptic children with short course of disease, non-secondary comprehensive attack type, low attack frequency and consistent localization of MRI and VEEG had good surgical effect. There was no significant relationship between the age of operation, the age of onset, the location of epileptic foci and the surgical effect of epileptic children. Conclusion: the surgical effect of MRI positive epileptic children is good, and the early surgical treatment of MRI positive epileptic children should be carried out. The surgical effect can be predicted according to the clinical factors and diagnostic results of the children in the course of surgical treatment.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R742.1

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