神经节细胞胶质瘤相关癫痫的外科治疗

目的 探讨神经节细胞胶质瘤（GG）相关癫痫手术治疗方法及效果。方法 2015年1月至2018年12月前瞻性收集GG相关癫痫共21例。根据癫痫病史、神经心理评估、长程视频脑电监测、头颅MRI及PET-CT等多模态Ⅰ期评估，15例在术中皮层脑电图（ECoG）监测下行裁剪式切除，6例行长程视频立体定向脑电图（SEEG）颅内深部电极植入术Ⅱ期评估后再行裁剪式切除术。结果 21例中，肿瘤等同于癫痫灶14例，肿瘤及边缘组织共为致痫灶5例，肿瘤周边组织为致痫灶2例。21例术后病理均为GG，合并局灶性皮质发育不良Ⅲb型7例（6例位于肿瘤边缘，1例位于肿瘤后缘2.6 cm处）。术后随访6~42个月，中位数为24个月，Engel分级Ⅰ级20例，Ⅱ级1例。结论 GG相关癫痫，肿瘤并不等同致痫灶。正确认识肿瘤与致痫灶的关系，致痫灶并肿瘤切除术是有效的手术方法。

Surgical treatment for patients with ganglioglioma-related epilepsy

Objective To investigate the treatment method for the patients with ganglioglioma (GG)-related epilepsy. Methods Twenty-one patients with GG-related epilepsy were recruited prospectively from January 2015 to December 2018. After the phase I evaluation by the analysis of the history of epilepsy, neuropsychological evaluation, long-term video EEG, MRI and PET-CT, 15 patients underwent resection mornitored by ECoG, and 6 underwent resection after phase Ⅱ evauluation by intracranial deep electrode implantation underguidance of long-range video stereoscopic EEG. Results The tumors were the epileptic foci in 14 patients, tumors and tissues adjacent to the tumors were epileptic foci in 5 patients, and tissues adjacent to the tumors were epileptic foci in 2 patients. The postoperative pathological findings showed GG in all the patients, with focal cortical dysplasia in 7 patients. Postoperative follow-up (range, 6~42 months; median, 24 months) showed Engel grade Ⅰ in 20 patients and grade Ⅱ in 1. Conclusions In GG-related epilepsy patients, the tumors are not equivalent to the epileptic foci. After correctly understanding of the relationship between the tumors and the epileptogenic foci, resection of the epileptic foci is an effective surgical method for the GG-related epilepsy.