致痫性局灶性皮质发育不良29例影像学特征、手术疗效和中期随访结果分析

目的:探索致痫性局灶性皮质发育不良(FCD)的影像学特征和手术疗效。方法:自2005年8月至2008年11月行手术切除并有完整随访资料的FCD患者29例,其中在全麻唤醒麻醉下手术12例,导航指引下手术5例,8例合并海马硬化者行前颞叶切除术。随访患者并分析其临床表现、影像学特征及手术疗效。结果:术中病理检查显示FCD患者Ⅰa型2例,Ⅰb型3例,Ⅱa型11例,Ⅱb型13例。术后平均随访52个月,结果显示癫痫控制情况:Eagel分级Ⅰ级72.4%(21/29),EagelⅡ级20.7%(6/29),EagelⅢ级6.9%(2/29)。术后偏瘫3例,在3～6个月完全恢复2例,明显改善1例;轻度运动性失语1例,6周逐渐恢复。无手术死亡病例。结论:磁共振检查是FCD术前诊断的有效手段。脑电监测下致痫性FCD的完全切除是获得满意疗效的前提。

Epileptogenic focal cortical dysplasia:neuroimage,surgery and medium-term follow-up results in 29 cases

Objective To explore the imaging characteristics and long-term outcome after epilepsy surgery of epileptogenic focal cortical dysplasia(FCD).Methods We retrospectively analyzed 29 cases of epileptogenic FCD.The pre-surgical evaluation including semiology,MRI,EEG and PET scan was performed.All epileptic lesion resection(29 cases) were performed with intro-oprative EEG monitoring,in which 12 cases with awake craniotomy and 5 cases assisted with neuron-navigation.Anterior temporal lobectomy was applied in 8 cases which was suspected with hippocampal sclerosis.Results All 29 cases had at least one lesion on preoperative MRI.According to Palmini classification,the resected tissue was classified as FCD type Ⅱb in 13 cases,Ⅱa in 11 cases,Ⅰb in 3 cases and Ⅰa type in 2 cases,respectively.After a mean follow-up of 52 months,for seizure control results,Eagel Ⅰ was achieved in 21 cases(72.4%),Eagel Ⅱ in 6 cases(20.7%),Eagel Ⅲ in 2 cases(6.9%).Postoperative hemiplegia occurred in 3 cases,2 of them gained full recovery in 3～6 months;and 1 of them markedly improved.Mild motor aphasia occurred in 1 cases and completely resolved in 6 weeks.There was no operative mortality.Conclusions MRI is an effective means for preoperative diagnosis of FCD.Complete resection of epileptic cortical dysplasia with EEG monitoring is a prerequisite for seizure control.