Nĕmecková J, Nĕmecek S, Náhlovský J, Parízek J, Sercl M
Department of Neurosurgery, Medical Faculty Charles University, Hradec Králové.
Sb Ved Pr Lek Fak Karlovy Univerzity Hradci Kralove. 1995;38(4):175-83.
In 1991-1993, 52 patients underwent surgery for low-grade supratentorial glioma. In 37 of them (astrocytoma 22, oligodentrocytoma 12, oligodendroglioma 2) seizures, often refractory to drug therapy, appeared as the first symptom. These cases were retrospectively analyzed. The patients had partial seizures: simple, complex, or secondarily generalized (preoperative duration: from 3 days to 17 years (mean 2 years); frequency: between 1 and 2/year and over 10/day). Neurological examination either revealed slight focal changes or was normal. Conventional craniotomy and resection of a tumor, without intraoperative electrocorticography, was performed. Partial resection was performed in 73%, subtotal in 5%, "total" in 22% of the cases. Postoperatively, 27 patients had focal radiotherapy, 3 of them in combination with chemotherapy. Two patients were reoperated. Out of 33 alive (89%), about two-thirds appear normal by neurological examination and are seizure-free at present (mean follow-up period 28 months). Most remain on antiepileptic drugs at lower doses. Histological and immunohistochemical analyses of resected tissue together suggest that the peripheral zone of cortical tumor infiltration may participate on epileptogenesis.
1991年至1993年，52例患者接受了幕上低级别胶质瘤手术。其中37例（星形细胞瘤22例，少突胶质细胞瘤12例，少突胶质瘤2例）首发症状为癫痫发作，且常常对药物治疗耐药。对这些病例进行了回顾性分析。患者均为部分性发作：简单部分性发作、复杂部分性发作或继发性全身性发作（术前病程：3天至17年，平均2年；发作频率：每年1至2次以及每天超过10次）。神经系统检查要么显示轻微局灶性改变，要么正常。在未进行术中皮质脑电图监测的情况下，实施了常规开颅肿瘤切除术。73%的病例进行了部分切除，5%为次全切除，22%为“全切除”。术后，27例患者接受了局部放疗，其中3例联合化疗。2例患者接受了再次手术。在33例存活患者（89%）中，约三分之二经神经系统检查显示正常，目前无癫痫发作（平均随访期28个月）。大多数患者仍服用低剂量抗癫痫药物。对切除组织的组织学和免疫组化分析共同表明，皮质肿瘤浸润的周边区域可能参与癫痫发生。
