以癫痫为主要症状的幕上占位病变的治疗探讨

目的探讨以癫痫为主要症状的幕上占位病变的治疗方法及效果。方法回顾性分析27例病例资料,在神经导航的辅助下切除病灶,术中进行皮层脑电监测,确定致痫灶的位置及范围,非功能区的予以切除,功能区的行皮层热灼。结果病灶完全切除23例,次全切除4例;12例行致痫灶切除,15例行皮层热灼;术后病检:胶质瘤14例,脑膜瘤8例,蛛网膜囊肿3例,肺癌脑转移2例;随访1～2年,大部分患者的癫痫症状消失,少数仍有癫痫发作,但发作频率、发作形式较术前明显改善,Engel分级:Ⅰ级23例(85.2%),Ⅱ级4例(14.8%)。结论以癫痫为主要症状的幕上占位病变,借助神经导航切除病灶,运用皮层脑电定位致痫灶,非功能区的予以切除,功能区的行皮层热灼,能很好地治疗癫痫,提高患者的生活质量。

Treatment strategy of supratentorial space -occupying lesion with epilepsy as main symptom

Objective To evaluate the treatment and therapeutic effect of supratentorial space-occupying lesion with epilepsy as the main symptom.Methods To retrospectively analyse the clinical data of 27 cases with supratentorial space-occupying lesion.All lesions were resected microscopically with the assistance of neuronavigation,and intraoperative cortical EEG monitoring was performed to determine the location and the range of epileptogenic zones.Epileptogenic zones was removed when localized in the non-functional areas,otherwise cortical thermocoagulation were performed in the functional areas.Results Among all cases,23 cases of lesions were completely removed and 4 cases were subtotally resected;12 cases underwent epileptogenic zone resection and 15 cases received cortical thermo-coagulatioin.Postoperative histopathologic examination:glioma 14 cases,meningioma 8 cases;arachnoid cysts 3 cases,2 cases of lung cancer with brain metastasis.Follow-up 1-2 years,most patients’ symptoms of epilepsy disappeared,but only a little number of patients still had seizures,the frequency and pattern of epilepsy were significantly better than preoperation.Engel classification:level I:23 cases(85.2%efficiency),gradeⅡ:4 cases(14.8% margins).Conclusions For the treatment of supratentorial space-occupying lesion with epilepsy as the main symptom,handling the epileptogenic zones properly with intraoperative cortical EEG monitoring after surgical excision by neural navigation could treat epilepsy better and improve patients’ life quality.