Packer R J, Sutton L N, Patel K M, Duhaime A C, Schiff S, Weinstein S R, Gaillard W D, Conry J A, Schut L
Department of Neurology, Children's National Medical Center, Washington, DC.
J Neurosurg. 1994 Jun;80(6):998-1003. doi: 10.3171/jns.1994.80.6.0998.
Detailed preoperative electroencephalographic (EEG) studies are now recommended for children with seizures and cortical tumors to define seizure foci prior to surgery. To develop a historical perspective for better evaluation of results from series reporting tumor removal combined with resection of seizure foci, the authors reviewed seizure outcome in 60 children with seizures and low-grade neoplasms treated consecutively since 1981 by surgical resection without concomitant EEG monitoring or electrocortical mapping. Forty-seven of the 60 tumors were totally or near-totally resected; 45 patients were seizure-free and two were significantly improved 1 year following surgery. Of the 50 children in this series with more than five seizures prior to surgery, 36 were seizure-free, two were significantly improved, and 12 were not improved. Factors associated with poor seizure control included a parietal tumor location, a partial tumor resection, and a history of seizures for more than 1 year prior to surgery. The children at highest risk for poor seizure control at 2 years had experienced seizures for more than 1 year prior to surgery and had undergone partial resection of their parietal low-grade glial tumors or gangliogliomas. In contradistinction, the best seizure control was seen in patients with totally resected low-grade gliomas or gangliogliomas who had experienced seizures for less than 1 year (concordance rates for being seizure-free ranged from 78% to 86%). Long-term seizure control remained excellent. These results suggest that seizure control can be obtained 2 years following tumor surgery in the majority of children with presumed tumors after extensive tumor resection without concomitant EEG monitoring or electrocortical mapping.
现在建议对患有癫痫和皮质肿瘤的儿童进行详细的术前脑电图（EEG）研究，以便在手术前确定癫痫病灶。为了从历史角度更好地评估报告肿瘤切除联合癫痫病灶切除系列研究的结果，作者回顾了自1981年以来连续接受手术切除且未同时进行脑电图监测或皮质电图描记的60例患有癫痫和低度肿瘤的儿童的癫痫发作结果。60例肿瘤中有47例实现了完全或近乎完全切除；45例患者术后1年无癫痫发作且2例有显著改善。在该系列中，术前癫痫发作超过5次的50例儿童中，36例无癫痫发作，2例有显著改善，12例无改善。与癫痫控制不佳相关的因素包括肿瘤位于顶叶、肿瘤部分切除以及术前癫痫发作病史超过1年。术前癫痫发作超过1年且接受了顶叶低度胶质瘤或神经节胶质瘤部分切除的儿童，在术后2年癫痫控制不佳的风险最高。相比之下，在经历癫痫发作少于1年的低度胶质瘤或神经节胶质瘤完全切除的患者中，癫痫控制效果最佳（无癫痫发作的符合率为78%至86%）。长期癫痫控制效果仍然良好。这些结果表明，在大多数疑似患有肿瘤的儿童中，在未同时进行脑电图监测或皮质电图描记的情况下进行广泛肿瘤切除术后2年，可以实现癫痫控制。
