Hartley L M, Gordon I, Harkness W, Harding B, Neville B G R, Cross J H
Neuroscience Unit, Great Ormond Street Hospital for Children NHS Trust, UK.
Dev Med Child Neurol. 2002 Oct;44(10):676-80. doi: 10.1017/s0012162201002742.
SPECT can be used to image regional cerebral blood flow (rCBF) and has been shown to help localize the seizure focus in partial epilepsies as part of the presurgical evaluation. Few studies have explored the possible relation between preoperative SPECT and underlying pathology, or any relation to postsurgical outcome. In this study preoperative ictal and interictal rCBF in relation to the histopathological diagnosis and outcome in a series of 35 children (24 females, 11 males; mean age 9.6 years, age range 11 months to 18 years) who had undergone resective surgery for epilepsy were retrospectively evaluated. A correlation between ictal hyperperfusion and the underlying responsible pathology was shown, with a consistent ictal increase in perfusion in developmental pathologies and Rasmussen's encephalitis, and consistent interictal hypoperfusion in hippocampal sclerosis (HS). No rCBF study parameter appeared to relate to outcome but in the group with HS the best outcome was seen in those with localizing ictal rCBF. The varied group of pathologies from hemispherectomy had excellent outcome but the SPECT findings had little to contribute over the abnormalities detected on MRI. In conclusion, rCBF studies remain a useful presurgical investigation in children with partial epilepsy, especially where HS, cortical dysplasia, or inflammatory disease are the underlying pathology. However, rCBF studies add little to the investigation of children with seizures secondary to benign tumours or cerebral infarcts, or where hemispherectomy is the likely preferred surgical option.
单光子发射计算机断层扫描（SPECT）可用于对局部脑血流（rCBF）进行成像，并且已被证明作为术前评估的一部分，有助于定位部分性癫痫的癫痫病灶。很少有研究探讨术前SPECT与潜在病理之间的可能关系，或与术后结果的任何关系。在本研究中，回顾性评估了35例接受癫痫切除手术的儿童（24例女性，11例男性；平均年龄9.6岁，年龄范围11个月至18岁）术前发作期和发作间期的rCBF与组织病理学诊断及结果的关系。结果显示发作期灌注增强与潜在的责任病理之间存在相关性，发育性病变和拉斯穆森脑炎发作期灌注持续增加，而海马硬化（HS）发作间期灌注持续减少。似乎没有rCBF研究参数与结果相关，但在HS组中，发作期rCBF定位的患者预后最佳。半球切除术患者的多种病理类型预后良好，但SPECT检查结果对MRI检测到的异常情况帮助不大。总之，rCBF研究仍是部分性癫痫患儿有用的术前检查，特别是在潜在病理为HS、皮质发育异常或炎症性疾病的情况下。然而，rCBF研究对继发于良性肿瘤或脑梗死的癫痫患儿，或可能首选半球切除术的患儿的检查帮助不大。
