Maruya J, Kayama T, Kuchiki H, Ando T
Department of Surgical Neurology Yamagata University School of Medicine.
No Shinkei Geka. 1997 Mar;25(3):265-9.
An 11-year-old female presented with headache in May 1993. Magnetic resonance (MR) imaging disclosed a small lesion (9 mm in diameter) in the left occipital lobe. No treatment was performed because the lesion was small. She subsequently developed frequent episodes of scintillating scotoma in the right visual field eleven months later. MR imaging eleven months after the first MR imaging showed the lesion had enlarged to 14 mm in diameter. Preoperative surface electroencephalography (EEG) detected no spike waves. The diagnosis was localized glioma. The mass was totally removed by gyrectomy in December 1994. Intraoperative cortical EEG demonstrated spike waves which disappeared after tumor removal. The histological diagnosis was pleomorphic xanthoastrocytoma. No postoperative neurological deficit was recognized, and scintillating scotoma and headache disappeared. Postoperative stereotactic radiosurgery was performed. The scintillating scotoma was caused by the tumor, because the spike wave and phase reversal were detected by the intraoperative cortical EEG. Intraoperative EEG is useful for the diagnosis of epilepsy caused by tumor. Sulcotomy and gyrectomy are the optimal surgical treatments for epilepsy caused by a localized glioma.
一名11岁女性于1993年5月出现头痛症状。磁共振成像（MR）显示左枕叶有一个小病灶（直径9毫米）。由于病灶较小，未进行治疗。11个月后，她右侧视野频繁出现闪光暗点。首次MR成像11个月后的MR成像显示病灶已增大至直径14毫米。术前头皮脑电图（EEG）未检测到棘波。诊断为局限性胶质瘤。1994年12月通过肿瘤切除术将肿块完全切除。术中皮层脑电图显示有棘波，肿瘤切除后消失。组织学诊断为多形性黄色星形细胞瘤。术后未发现神经功能缺损，闪光暗点和头痛消失。进行了术后立体定向放射外科治疗。闪光暗点是由肿瘤引起的，因为术中皮层脑电图检测到了棘波和相位反转。术中脑电图对诊断肿瘤引起的癫痫有用。脑沟切开术和肿瘤切除术是治疗局限性胶质瘤引起的癫痫的最佳手术方法。
