Arai Nobutaka, Takahashi Tatsuya, Komori Takashi, Yagishita Akira, Shimizu Hiroyuki
Department of Clinical Neuropathology, Tokyo Metropolitan Institute for Neuroscience, Tokyo, Japan.
Neuropathology. 2007 Dec;27(6):594-600. doi: 10.1111/j.1440-1789.2007.00811.x.
As neurosurgical treatments have been increasingly applied to patients who have intractable epilepsy, much knowledge on pathological changes in surgically removed brain tissues have become clearer in recent years, as well as on the neuroimaging findings which are analyzed with a variety of techniques, including computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET), single photon emission computed tomography (SPECT) in combination with digital imaging and communication in medicine (DICOM), statistical parametric mapping (SPM), subtraction ictal SPECT coregistered to MRI (SISCOM) and/or PET-guided intraoperative navigation system, as mentioned in detain in another article in this issue by Maehara et al. Representative and relatively common diseases, treated by epilepsy-surgery, are as follows; hippocampal sclerosis, amygdaloid sclerosis, coarse and macroscopic brain malformation (focal cortical dysplasia, hemimegalencephaly, tuberous sclerosis), tumors (dysembryoplastic neuroepithelial tumor, ganglioglioma, etc.), destructive lesions and the others. It is a fact, however, that there remains many problems in the diagnostic criteria or histological grading systems, especially in various cortical dysplasias described above. On the other hand, histologically minor but clinically serious lesions have become to be known through careful observations on surgically removed tissues which showed no neuroradiological findings. A good well-known example is microdysgenesis of the cerebrum which is characterized by the presence of both the white mater ectopic neurons and the vascular meandering abnormalities with glial satellitosis. There must be another important histological phenotypes of microdysgenesis, except the above-mentioned ones, that are not yet established at present. Therefore, it is believed that there remains various problems on the diagnostic neuropathology of epileptic lesions with or without neuroimaging findings in which we have to give answers in a few days to come.
随着神经外科治疗越来越多地应用于难治性癫痫患者，近年来，关于手术切除脑组织的病理变化以及通过多种技术分析的神经影像学发现的认识越来越清晰，这些技术包括计算机断层扫描（CT）、磁共振成像（MRI）、正电子发射断层扫描（PET）、单光子发射计算机断层扫描（SPECT）与医学数字成像和通信（DICOM）相结合、统计参数映射（SPM）、与MRI配准的发作期SPECT减影（SISCOM）和/或PET引导的术中导航系统，正如本期另一篇文章中前原等人详细提到的那样。通过癫痫手术治疗的典型且相对常见的疾病如下：海马硬化、杏仁核硬化、粗大和宏观脑畸形（局灶性皮质发育不良、半侧巨脑症、结节性硬化症）、肿瘤（胚胎发育不良性神经上皮肿瘤、神经节胶质瘤等）、破坏性病变及其他。然而，事实上，在诊断标准或组织学分级系统方面仍存在许多问题，尤其是在上述各种皮质发育不良方面。另一方面，通过对手术切除组织进行仔细观察，发现了一些组织学上轻微但临床上严重的病变，这些病变在神经放射学检查中未显示异常。一个广为人知的例子是大脑微发育异常，其特征是存在白质异位神经元以及伴有胶质细胞卫星现象的血管迂曲异常。除上述情况外，微发育异常肯定还有其他重要的组织学表型，目前尚未确定。因此，人们认为，在癫痫病变的诊断神经病理学方面，无论有无神经影像学发现，都仍然存在各种问题，我们必须在未来几天内给出答案。
