胚胎发育不良性神经上皮肿瘤继发癫痫的外科治疗

目的 探讨胚胎发育不良性神经上皮肿瘤（DNT）继发癫痫的临床特点和手术疗效。方法 回顾性分析2014年12月至2019年1月手术治疗并经病理证实的53例DNT合并癫痫的临床资料。结果 肿瘤次全切除9例，全切除23例，扩大切除21例。术后病理检查结果均为DNT，其中合并局灶性脑皮质发育不良20例、海马硬化4例、神经节细胞胶质瘤4例。术后随访1~3年，Engel分级Ⅰ级43例（81.1%；其中MRI分型Ⅰ型29例，Ⅱ型11例，Ⅲ型3例），Ⅱ级4例（7.5%），Ⅲ级4例（7.5%），Ⅳ级2例（3.8%）；术后复查MRI未见肿瘤复发或进展。结论 DNT继发癫痫多为药物难治性癫痫，手术切除可取得良好效果。术前需综合评估病变部位和影像学特点等制定相应的手术方案，术中尽可能全切肿瘤，有助于提高手术疗效。

Surgical treatment of patients with epilepsy due to dysembryoplastic neuroepithelial tumors

Objective To study the clinical features and surgical outcomes of the patients with epilepsy due to dysembryoplastic neuroepithelial tumors (DNT). Methods The clinical data of 53 patients with epilepsy due to DNT were retrospectively analyzed. Results According to the MRI classification, 33 patients belonged to type Ⅰ, 15 to type Ⅱ and 5 to type Ⅲ. Subtotal resection was achieved in 9 patients, total resection in 23 and expanded resection in 21. The postoperative pathological results showed DNT in all the patients, of whom 20 patients had focal cerebral cortex dysplasia, 4 had hippocampal sclerosis and 4 had ganglion cell glioma. The follow-up (range, 1~3 years) results showed Engel grade Ⅰ in 43 patients (81.1%, including 29 patients of MRI classification type Ⅰ, 11 of type Ⅱ and 3 of type Ⅲ), grade Ⅱin 4 (7.5%), grade Ⅲ in 4 (7.5%), grade Ⅳ in 2 (3.8%). The MRI showed no tumor recurrence or progression. Conclusions The epilepsy due to DNT is mostly drug-resistant epilepsy, and surgical resection can achieve good outcomes. The measures, including preoperative comprehensive evaluation of the location and imaging characteristics and resection of the tumor as more as possible, are helpful to improve the curative effect.