Tian Ashley G, Edwards Michael S B, Williams Nicole J, Olson Donald M
Department of Neurosurgery, Stanford University Medical Center, Stanford, California 94305-5327, USA.
J Neurosurg Pediatr. 2011 Mar;7(3):229-34. doi: 10.3171/2010.12.PEDS10293.
Intractable epilepsy following successful brain tumor surgery in children may have several underlying causes such as residual tumor, cortical dysplasia, and gliosis. The authors reviewed the cases of children who had previously undergone resection of a brain tumor only to have medically refractory seizures postoperatively.
The authors performed a retrospective case review of 9 children who underwent brain tumor surgery 2-13 years before undergoing a second surgery to try and control their seizures.
Eight of 9 children had seizures at the time of tumor presentation. Tumor types included ganglioglioma, dysembryoplastic neuroepithelial tumor, pilocytic astrocytoma, oligodendroglioma, ependymoma, and choroid plexus papilloma. All patients achieved a seizure-free interval before intractable seizures recurred. After the second operation, 3 children were seizure free, 1 only had auras, 2 had rare complex partial seizures, and 3 continued to have relatively frequent seizures, although the frequency and severity were reduced. Seven of 9 patients had pathology showing residual tumor.
Epilepsy surgery following earlier brain tumor surgery can provide substantial benefit with reduced seizure number and severity. Despite reassuring brain imaging results, residual tumor was present more often than expected in pathological specimens.
儿童脑肿瘤手术成功后出现的难治性癫痫可能有多种潜在原因，如残留肿瘤、皮质发育异常和胶质增生。作者回顾了那些先前接受过脑肿瘤切除术但术后出现药物难治性癫痫发作的儿童病例。
作者对9名儿童进行了回顾性病例分析，这些儿童在接受第二次手术以控制癫痫发作之前2至13年接受了脑肿瘤手术。
9名儿童中有8名在肿瘤出现时就有癫痫发作。肿瘤类型包括神经节细胞胶质瘤、胚胎发育不良性神经上皮肿瘤、毛细胞型星形细胞瘤、少突胶质细胞瘤、室管膜瘤和脉络丛乳头状瘤。所有患者在难治性癫痫复发前都有一段无癫痫发作期。第二次手术后，3名儿童无癫痫发作，1名仅有先兆，2名有罕见的复杂部分性发作，3名尽管发作频率和严重程度有所降低，但仍有相对频繁的癫痫发作。9名患者中有7名的病理显示有残留肿瘤。
早期脑肿瘤手术后的癫痫手术可显著减少癫痫发作次数和严重程度，带来益处。尽管脑成像结果令人放心，但病理标本中残留肿瘤的出现比预期更为常见。
