儿童颅内病变性癫痫影响手术效果的因素分析

目的 对儿童颅内局灶性病变伴癫痫外科治疗后影响其预后的相关因素进行探讨.方法 收集我科自2003年6月至2007年6月间收治的颅内局灶性病变伴癫痫的患儿71例,运用统计学方法对其病理结果、发病至手术时间、发病年龄、手术治疗年龄及脑电图结果等因素与患儿预后的关系进行分析,其预后运用Engel's system进行分级.结果 患儿颅内病变病理性质与其预后无相关,本组病例中各病理组之间对患儿术后癫痫的控制效果无统计学意义.发病至手术时间越短,发病年龄较小,手术治疗越早期,预后较好.VEEG提示放电范围广泛者预后较差,本组病例中术前VEEG监测示痫性放电累及多个脑叶或对侧大脑半球则术后癫痫控制效果较差.结论 对颅内局灶性病变伴癫痫患儿应首选早期手术治疗,VEEG提示放电范围广泛者预后较差.

Prognostic factors of surgical treatment of epileptic children with focal intracranial lesions

Objective To establish the prognostic factors for surgical treatment of epileptic children with focal intracranial lesions. Methods We reviewed 71 epileptic children with intracranial focal lesions managed in our institute from June 2003 to June 2007. Results The factors affecting the postoperative outcome included the duration between seizure onset and the operation, the age at onset, the age when operations were performed, VEEG outcome. Statistically, the pathology of the lesions did not influence the outcome. The shorter the period between the first onset and operations, the younger age of the children when the first seizure occurred, the earlier when the operations undertaken, the better the prognosis. The preoperative VEEG showed diffuse epileptic discharge over multiple lobes and contralateral hemisphere was associated with worse operation results in our series. Conclusions Surgical treatment of epilepsy in children with intracranial focal lesions should be selective and early.