皮层电极监测下切除致痫性脑胶质瘤的临床研究

目的使用皮层电极监测切除致痫性脑胶质瘤，探讨致痫性脑胶质瘤的治疗方法。方法本组病人43例。EEG示轻度异常脑电图9例，巾度异常脑电罔26例，重度异常脑电图8例。CT或MRI检查皆可见占位病变。常规手术开颅显露相应部位脑皮层使用皮层电极对脑电进行监测。确定大体致痫范围，行肿瘤切除。肿瘤切除后再行脑电监测，若仍有癫痫波，根据皮层电极之定位切除致痫灶。结果22例病人行显微镜下肿瘤全切除，15例病人近全切除肿瘤．6例病人次全切除肿瘤。术后随访6个月～6年。34例(79．1％)病人癫痫症状消失，7例(16.3％)病人癫痫发作次数明显减少，2例(4．7％)病人癫痫症状未见好转。总有效率(93．7％)。结论以癫痫为主要症状的脑肿瘤病人．只有在切除胶质瘤时一并切除致痫灶，才是治疗肿瘤并根治癫痫的最佳方法。皮层电极监测下切除致痫性脑胶质瘤是治疗有癫痫症状的脑胶质瘤的有效方法。

Resection of epilepsytogenic glioma with the cortex electrode

Objective With the cortex electrode, we monitored the course of resecting the epilepsytogenic glioma so as to discuss the treatment of the epileptogenic glioma. Methods 43 cases of epilepsytogenic glioma were examined with EEG, showing 9 cases were slightly abnormal, 26 abnormal, 8 cases severely abnormal. CT or MRI scan showed mass lesion existed in 43 cases. Routine craniotomy was performed to expose the corresponding cortical lesion. Then the EEG of lesion was monitored with the cortex electrode. On locating the lesion causing epilepsy with epilepic waves, it was resected. Following resection, EEG monitoring was done in terms of epilepic waves. If epilepic waves were detected once more, epilepic foci were resected based on the location with cortex electrode. Results 22 tumors are totally removed by microsurgery, 15 tumors nearly totally removed, 6 tumors subtotally removed. Follow-up varied from 6 months to 6 years. 34 (79.1%) cases were free from epilepic seizure, 7 (16.3 %) cases greater reduction from baseline in seizure, 2 (4.7 %) cases no effective. The total effective rate reached 93.7 %. Conclusion As for glioma patients with a main symptom of epilepic seizure, the resection of epileptogenic lesions at the same time of gliomaectomy is the most effective. Resection of the epileptogenic under monitoring with cortical electrode is also the most effective in treating glioma with the symptom of epilepsy.