Brahimaj Bledi, Greiner Hansel M, Leach James L, Horn Paul S, Stevenson Charles B, Miles Lili, Byars Anna, Holland Katherine, Sutton Mary, Mangano Francesco T
College of Medicine, University of Cincinnati, Cincinnati, OH, USA.
Childs Nerv Syst. 2014 Aug;30(8):1383-91. doi: 10.1007/s00381-014-2427-2. Epub 2014 Apr 26.
Children suffering from epilepsy with suspected low-grade tumors may benefit from a surgical approach that considers the epileptogenic zone, which can be more extensive than the tumor region. This study aimed to determine the prevalence of epilepsy in children undergoing supratentorial tumor resection and the factors predictive of postoperative seizure freedom in children with low-grade tumors.
Subjects 3 months to 21 years undergoing supratentorial brain tumor resection between 2007 and 2011 were included in this retrospective study. Children with supratentorial, cortically based tumors and a preoperative diagnosis of epilepsy were considered epilepsy surgery candidates. Pre- and postoperative MRI were reviewed and scored for extent of resection, adjacent dysplasia, and remaining abnormal cortex postoperatively.
The prevalence of seizures in all cases of supratentorial tumors was 46/87 (53 %). Eighteen were epilepsy surgery candidates. Eight of 18 (44 %) were seizure-free postoperatively with a mean follow-up of 39 months. Children who were seizure free postoperatively had tried fewer anticonvulsants than those with continued seizures (1.7 v. 2.9, p = 0.01). Presurgical evaluation was nonstandardized, and a more extensive workup and resection were performed in children who continued to have seizures postoperatively.
All epilepsy surgery candidates had low-grade tumors on histological evaluation, indicating that a surgical approach that takes into consideration the epileptogenic zone is reasonable in this population. Gross total resection should be the goal, with additional attention to resection of the epileptogenic zone when located in the noneloquent cortex.
患有癫痫且疑似低度肿瘤的儿童可能受益于一种考虑致痫区的手术方法，致痫区可能比肿瘤区域更广泛。本研究旨在确定幕上肿瘤切除儿童中癫痫的患病率以及低度肿瘤儿童术后无癫痫发作的预测因素。
本回顾性研究纳入了2007年至2011年间接受幕上脑肿瘤切除的3个月至21岁的受试者。患有幕上皮质性肿瘤且术前诊断为癫痫的儿童被视为癫痫手术候选者。对术前和术后的MRI进行回顾，并对切除范围、相邻发育异常和术后残留异常皮质进行评分。
所有幕上肿瘤病例中癫痫发作的患病率为46/87（53%）。18名是癫痫手术候选者。18名中有8名（44%）术后无癫痫发作，平均随访39个月。术后无癫痫发作的儿童比仍有癫痫发作的儿童尝试使用的抗惊厥药物更少（1.7比2.9，p = 0.01）。术前评估不规范，对术后仍有癫痫发作的儿童进行了更广泛的检查和切除。
所有癫痫手术候选者在组织学评估中均为低度肿瘤，这表明在该人群中采用考虑致痫区的手术方法是合理的。应将肿瘤全切作为目标，当致痫区位于非语言皮质时，应额外注意对其进行切除。
