脑皮质发育不良继发顽固性癫痫的病理分型及手术治疗

目的 探讨局灶性脑发育不良(FCD)的临床特征、病理学、影像学的特点及手术疗效.方法 42例外科手术切除致痫灶并经病理证实为FCD的患者中,根据Palmini病理学分型进行分类,并对其临床特征、影像学特点及手术疗效进行回顾性分析.结果 42例患者中,按致痫灶部位分类颢叶24例、额叶14例、顶叶6例及枕叶3例,其中多脑叶5例.术前影像学检查阳性率62%.组织学分型FCDⅠA型9例,FCDⅠB型21例,FCDⅡA型5例,FCDⅡB型7例,其中以FCD Ⅰ B型最为常见,多位于颞叶且常伴有海马硬化.所有患者术后至少随访1年以上,癫痫术后治愈率FCD位于颞叶67%,颞叶以外43%(EngleⅠa).结论 FCD是难治性癫痫常见的病理学改变,其病理分型与临床特征和致痫灶部位存在相关性,为制定手术方案和判定手术效果提供了依据.

Clinicopathological features and surgical outcomes of intractable epilepsy due to focal cortical dysplasia

Objective To study the correlation with subtypes of focal cortical dysplasia(FCD) and surgical outcomes in patients with intractable epilepsy due to FCD.Method According to Palmini's FCD classification,the clinical,radioiogical and pathological features of 42 intractable epilepsy patients of FCD received surgical treatment were reviewed retrospectively.Results Among 42 epilepsy patients,the FCD lesions were located in 24 temporal lobes,14 frontal lobes,6 parietal lobes,3 occipital lobes,5 multilple lesions.The positive rate of preoperative MRI examination was 62%.The subtypes of FCD were identified as following:FCD type Ⅰ A in 9,FCD type Ⅰ B in 21,FCD type Ⅱ A in 5 and FCD type Ⅱ B in 7,respectively.FCD type Ⅰ B was the predominant pathological subtype and almost located in temporal lobe associated hippocampal sclerosis.The curative rate of FCD surgery in temporal lobe epilepsy group was 67% and that in extratemporal group was 43% (Engle Ⅰ a)during follow -up period (at leastⅠ year).Conclusions FCD is a common cause of intractable epilepsy.The different intrinsic neuropathological characteristics,particularly the potential epileptogenic feature,have significant correlations with clinical findings.Further study should be made between each category with its surgical outcome.