Pilcher W H, Silbergeld D L, Berger M S, Ojemann G A
Division of Neurological Surgery, University of Rochester Medical Center, New York.
J Neurosurg. 1993 Jun;78(6):891-902. doi: 10.3171/jns.1993.78.6.0891.
Gangliogliomas are indolent neoplasms that are often associated with long-standing intractable seizures. The seizure-free outcome following ganglioglioma resection alone (or "lesionectomy") has been generally favorable, ranging in most series from 50% to 65%. Thus, the value of resection of epileptogenic cortex in addition to tumor with regard to seizure outcome has been the subject of controversy. The authors describe a series of 12 patients with frontal or temporal lobe gangliogliomas associated with long-standing intractable seizures. In these patients, intraoperative electrocorticography was used to guide the resection of epileptogenic cortex along with tumor. Functional brain mapping, interictal and ictal monitoring of seizures, as well as thorough neuropsychological assessments were performed prior to resection in all cases. Outcome with regard to seizures, tumor recurrence, and neurological deficits was assessed with a mean follow-up period of 3.1 years. There was universal freedom from seizures postoperatively in 11 patients in whom complete or near-complete resection of epileptogenic cortex was achieved. In one patient in whom complete tumor resection and subtotal removal of epileptogenic cortex was achieved, a 95% reduction in seizure frequency was identified. No tumor recurrence or neurological deficits were observed. In a subset of four patients, neuropsychological and cognitive function were evaluated pre- and postoperatively. In these four, a clear trend toward improvement was noted in most functions. Thus, resection of epileptogenic cortex along with tumor may improve seizure outcome in selected patients with tumor-associated epilepsy without engendering identifiable neurological or cognitive deficits attributable to the incremental resection.
神经节细胞胶质瘤是一种生长缓慢的肿瘤，常与长期难治性癫痫发作相关。单纯切除神经节细胞胶质瘤（或“病灶切除术”）后的无癫痫发作结果通常较好，在大多数系列研究中，无癫痫发作率在50%至65%之间。因此，除肿瘤切除外，切除致痫皮层对癫痫发作结果的价值一直存在争议。作者描述了一组12例额叶或颞叶神经节细胞胶质瘤伴长期难治性癫痫发作的患者。在这些患者中，术中皮层脑电图用于指导致痫皮层和肿瘤的切除。所有病例在切除术前均进行了脑功能图谱绘制、发作间期和发作期癫痫监测以及全面的神经心理学评估。对癫痫发作、肿瘤复发和神经功能缺损的结果进行了评估，平均随访期为3.1年。11例实现了致痫皮层完全或近乎完全切除的患者术后均无癫痫发作。1例实现了肿瘤完全切除和致痫皮层大部分切除的患者，癫痫发作频率降低了95%。未观察到肿瘤复发或神经功能缺损。在4例患者的亚组中，对其术前和术后的神经心理学和认知功能进行了评估。在这4例患者中，大多数功能均呈现出明显的改善趋势。因此，对于某些肿瘤相关性癫痫患者，切除致痫皮层和肿瘤可能会改善癫痫发作结果，且不会因额外切除而导致可识别的神经或认知缺陷。
