颅内肿瘤伴发癫的机制及外科治疗评价

临床上常见脑肿瘤伴发癫,但脑肿瘤与癫发生的关系仍很难确定。癫放电是脑皮层超同步放电的结果,无论是原发性还是继发性癫,都是大脑功能异常的表现,致灶脑生物电变化较其组织形态学变化更明显。因此,对颅内肿瘤伴发癫患者进行致灶定位时,既不同于单纯颅内占位病变者,也有别于其它顽固性癫患者。除了需要神经影像学检查发现病灶外,更要参考V-EEG的结果,结合临床表现和其它术前评估手段进行联合定位具有更大价值。在神经影像学和电生理指导下,行病变切除术+致灶切除术(或阻断性活动扩散的手术,如多处软膜下横切),可获得较好疗效,但并不能确保所有患者术后癫终止发作或得到明显改善。随着更多基础与临床研究的深入,人们对癫发病机制的理解将会更加深刻,对此类疾病的诊治也将会达到更高水平。

Mechanism of Epilepsy with Brain Tumor and its Surgical Treatment

Although brain tumors which cause seizures are often seen in the clinic practice, the relation between tumor and epilepsy still remains unclear. Epileptic discharges are the result of synchronized discharges of cortex. Either primary or secondary epilepsy reflects the dysfunction of the brain, and bioelectrical changes of epileptic focus are more evident compared to histological changes. Therefore, the localization of epileptic focus in patients with epilepsy caused by brain tumor depends not only upon the neuroimaging data, but also on Video-EEG, which will be more helpful, if clinical manifestation and other presurgical examination are considered. Under the instruction of neuroimaging and neuroelectrical examination, removal of lesions plus resection of epileptic focus might serve as an effective strategy. However, not all cases are completely seizure-free after operation. Understanding of the mechanism of epilepsy with brain tumor may help improve the prognosis of patients.