Valenti M P, Froelich S, Armspach J P, Chenard M P, Dietemann J L, Kerhli P, Marescaux C, Hirsch E, Namer I J
Unité d'Explorations Fonctionnelles des Epilepsies, Clinique Neurologique, Hopitaux Universitaires de Strasbourg, France.
Epilepsia. 2002 Mar;43(3):270-6. doi: 10.1046/j.1528-1157.2002.25101.x.
Dysembryoplastic neuroepithelial tumors (DNTs) are a group of glioneuronal supratentorial and intracortical lesions often associated with the early onset of intractable and crippling partial seizures. They are characterized by their location, multinodular architecture, and heterogeneous cell composition, with a specific glioneuronal element in the specific form. Foci of cortical dysplasia may be associated with the tumoral lesion, and identifying the presence and the extent of cortical dysplasia is not always easy on magnetic resonance images (MRIs). The purpose of this article is to evaluate, retrospectively, the usefulness of ictal single-photon emission computed tomography (SPECT) imaging to assess the presence and the extent of cortical dysplasia associated with DNTs in nine patients with intractable temporal lobe epilepsy related to histopathologically confirmed DNTs.
The results of the subtraction of ictal and interictal SPECT coregistered to MRI (SISCOM) were compared with the results of the examinations of pathological material after surgery.
SISCOM showed a strongly hyperperfused area corresponding anatomically to electroclinical abnormalities and to the location of DNTs on MRI. A circumscribed hyperperfusion was present in DNTs without cortical dysplasia, limited to the location of the tumor on MRI. In cases of associated cortical dysplasia, a widespread hyperperfusion including areas corresponding to normal perilesional regions on MRI was found.
SISCOM, used among presurgical investigations, contributes to detecting cortical dysplasia associated with DNTs. Concordance between the symptomatogenic zone (defined from the medical history and electroclinical data), MRI scans, SISCOM pattern, and complete resection of the epileptic zone was predictive of a good postsurgical outcome.
胚胎发育不良性神经上皮肿瘤（DNTs）是一组幕上和皮质内的神经胶质神经元病变，常与难治性致残性部分性癫痫的早期发作相关。它们的特征在于其位置、多结节结构和异质性细胞组成，具有特定形式的特定神经胶质神经元成分。皮质发育异常灶可能与肿瘤性病变相关，而在磁共振成像（MRI）上识别皮质发育异常的存在和范围并不总是容易的。本文的目的是回顾性评估发作期单光子发射计算机断层扫描（SPECT）成像在评估9例与组织病理学证实的DNTs相关的难治性颞叶癫痫患者中与DNTs相关的皮质发育异常的存在和范围的实用性。
将与MRI配准的发作期和发作间期SPECT相减结果（SISCOM）与手术后病理材料检查结果进行比较。
SISCOM显示一个强烈高灌注区域，在解剖学上对应于电临床异常和MRI上DNTs的位置。在无皮质发育异常的DNTs中存在局限性高灌注，仅限于MRI上肿瘤的位置。在伴有皮质发育异常的病例中，发现广泛的高灌注，包括MRI上对应于正常病变周围区域的区域。
术前检查中使用的SISCOM有助于检测与DNTs相关的皮质发育异常。症状发生区（根据病史和电临床数据定义）、MRI扫描、SISCOM模式与癫痫区的完全切除之间的一致性可预测良好的术后结果。
